9c4a4b9e8244dc8b0070771c2786aeec muscles-04-00039.pdf 4dceaf3d78b760679f3fa30c04120a64f1991623 muscles-04-00039.pdf dfac729340cdbc1ef646523209eed2f95fdbc30d7191de2654c5b171b24f104e muscles-04-00039.pdf Title: Annular Ligament Instability in Lateral Elbow Pathology: Objective Confirmation Through a Cadaveric Study Subject: Background: The annular ligament is a key secondary stabilizer of the elbow, but its biomechanical behavior during forearm rotation has not been objectively quantified. This study aimed to assess interindividual variability in annular ligament tension, validate prior arthroscopic observations, and explore associations with chondral lesions in the lateral elbow compartment. Methods: In this cross-sectional anatomical study, 25 cadaveric upper limbs were analyzed following standardized dissection, preserving ligamentous and muscular integrity. Ligament displacement was measured using a custom mechanical apparatus and high-precision digital micrometer in neutral, 60 pronation, and 60 supination positions under axial tractions of 1, 2, and 3 kg. Ulnar length and presence of chondral lesions were also recorded. Results: Maximal ligament displacement occurred in supination in 80% of specimens (mean: 1.23 mm at 3 kg; range: 0.30–2.87 mm), indicating considerable interindividual variation. Significant displacement differences were observed between all forearm positions across load levels (p < 0.001). Chondral lesions were identified in three specimens with marked ligament laxity and reduced radial head coverage. Conclusions: This study provides the first objective evidence of annular ligament tension variability during forearm rotation. Ligament laxity may contribute to lateral elbow instability and cartilage degeneration, supporting the ligament’s role as a secondary stabilizer. Keywords: anular ligament; elbow instability; cadaveric study Author: Daniel Berlanga de Mingo, Guillem Paz Ramírez, Arnau Moreno Garcia, Maria Tibau Alberdi, Diana Noriego Muñoz, Miguel Pérez Abad, Giacomo Rossettini, Jorge Hugo Villafañe, César Abellán Miralles, Montserrat del Valle Jou, Àngel Ferreres Claramunt and Alfonso Rodríguez Baeza Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Mon Sep 15 10:00:39 2025 CEST ModDate: Mon Sep 15 10:05:16 2025 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 3553803 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- DMTLJA+VnURWPalladioL Type 1 Custom yes yes yes 102 0 KNCLZS+URWPalladioL-Bold Type 1 Custom yes yes yes 103 0 MJTSWJ+URWPalladioL-Roma Type 1 Custom yes yes yes 104 0 WTAUCZ+CMSY10 Type 1 Builtin yes yes yes 105 0 PGPDYS+VnURWPalladioL-Bold Type 1 Custom yes yes yes 106 0 EQKHEL+URWPalladioL-Ital Type 1 Custom yes yes yes 107 0 OVNEXW+EURM10 Type 1 Builtin yes yes yes 179 0 EOMPPO+PalatinoLinotype TrueType WinAnsi yes yes no 175 0 EONAAA+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 191 0 EOMPPO+PalatinoLinotype TrueType WinAnsi yes yes no 192 0 EOMPPO+PalatinoLinotype TrueType WinAnsi yes yes no 215 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 231 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-02-12 04:20:35 CET RepresentationInformation: muscles-04-00039.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-02-11 12:01:58 CET Size: 3553803 Format: PDF Version: 1.5 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 313 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Children: Item: Title: Study Design and Ethical Approval Item: Title: Specimens and Dissection Item: Title: Measurement Apparatus and Protocol Item: Title: Validation and Data Collection Item: Title: Statistical Analysis Item: Title: Results Item: Title: Discussion Children: Item: Title: Applications for Clinical Practice and Future Research Lines Item: Title: Limitations of the Study Item: Title: Conclusions Item: Title: References Info: Title: Annular Ligament Instability in Lateral Elbow Pathology: Objective Confirmation Through a Cadaveric Study Author: Daniel Berlanga de Mingo, Guillem Paz Ramírez, Arnau Moreno Garcia, Maria Tibau Alberdi, Diana Noriego Muñoz, Miguel Pérez Abad, Giacomo Rossettini, Jorge Hugo Villafañe, César Abellán Miralles, Montserrat del Valle Jou, Àngel Ferreres Claramunt and Alfonso Rodríguez Baeza Subject: Background: The annular ligament is a key secondary stabilizer of the elbow, but its biomechanical behavior during forearm rotation has not been objectively quantified. This study aimed to assess interindividual variability in annular ligament tension, validate prior arthroscopic observations, and explore associations with chondral lesions in the lateral elbow compartment. Methods: In this cross-sectional anatomical study, 25 cadaveric upper limbs were analyzed following standardized dissection, preserving ligamentous and muscular integrity. Ligament displacement was measured using a custom mechanical apparatus and high-precision digital micrometer in neutral, 60 pronation, and 60 supination positions under axial tractions of 1, 2, and 3 kg. Ulnar length and presence of chondral lesions were also recorded. Results: Maximal ligament displacement occurred in supination in 80% of specimens (mean: 1.23 mm at 3 kg; range: 0.30–2.87 mm), indicating considerable interindividual variation. Significant displacement differences were observed between all forearm positions across load levels (p < 0.001). Chondral lesions were identified in three specimens with marked ligament laxity and reduced radial head coverage. Conclusions: This study provides the first objective evidence of annular ligament tension variability during forearm rotation. Ligament laxity may contribute to lateral elbow instability and cartilage degeneration, supporting the ligament’s role as a secondary stabilizer. 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