Journal of Shoulder and Elbow Surgery

Insertional anatomy of the anterior medial collateral ligament on the sublime tubercle of the elbow

Published:October 31, 2018DOI:


      Acute injuries to the anterior medial collateral ligament (AMCL) can occur due to valgus trauma or during other dislocating events to the elbow. AMCL lesions are often associated with bony lesions, such as radial head fractures or fractures of the coronoid process. We analyzed the insertion of the AMCL on the sublime tubercle in relation to surrounding osseous structures. We aimed to increase the understanding of the involvement of the AMCL in bony lesions to the sublime tubercle.


      We investigated 86 elbows from 43 embalmed human specimens. We measured the most ventral extensions of the AMCL at the sublime tubercle in relation to a clearly defined and reproducible landmark. We used as our landmark a horizontal line (baseline) originating on the lesser sigmoid notch in a right angle to the ulnar ridge.


      The mean distance of the coronoid process tip to the baseline was 4.0 mm (standard deviation [SD], 1.3 mm; range, 1.4-6.7 mm). The mean distance of the ventral extension of the AMCL to the horizontal line was 3.7 mm (SD, 2.6 mm; range: 9.4-2.2 mm). The mean horizontal distance between the ventral aspect of the AMCL and the coronoid tip was 13.7 mm (SD, 2.5 mm; range, 7.7-20.5 mm).


      We present a detailed description of the insertional anatomy of the AMCL at the sublime tubercle. These values could be helpful for classifications of coronoid fractures and to estimate the involvement of the AMCL in fractures of the sublime tubercle.

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        • Ablove R.H.
        • Moy O.J.
        • Howard C.
        • Peimer C.A.
        • S'Doia S.
        Ulnar coronoid process anatomy: possible implications for elbow instability.
        Clin Orthop Relat Res. 2006; 449: 259-261
        • Cage D.J.
        • Abrams R.A.
        • Callahan J.J.
        • Botte M.J.
        Soft tissue attachments of the ulnar coronoid process.
        Clin Orthop Relat Res. 1995; 320: 154-158
        • Camp C.L.
        • Conte S.
        • D'Angelo J.
        • Fealy S.A.
        Following ulnar collateral ligament reconstruction, professional baseball position players return to play faster than pitchers, but catchers return less frequently.
        J Shoulder Elbow Surg. 2018; 27: 1078-1085
        • Chan K.
        • Faber K.J.
        • King G.J.
        • Athwal G.S.
        Selected anteromedial coronoid fractures can be treated nonoperatively.
        J Shoulder Elbow Surg. 2016; 25: 1251-1257
        • Cohen M.S.
        • Bruno R.J.
        The collateral ligaments of the elbow: anatomy and clinical correlation.
        Clin Orthop Relat Res. 2001; 383: 123-130
        • Conway J.E.
        • Jobe F.W.
        • Glousman R.E.
        • Pink M.
        Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament.
        J Bone Joint Surg Am. 1992; 74: 67-83
        • Davidson P.A.
        • Moseley Jr, J.B.
        • Tullos H.S.
        Radial head fracture. A potentially complex injury.
        Clin Orthop Relat Res. 1993; 297: 224-230
        • Docquier P.L.
        • Paul L.
        • Cartiaux O.
        • Lecouvet F.
        • Dufrane D.
        • Delloye C.
        • et al.
        Formalin fixation could interfere with the clinical assessment of the tumor-free margin in tumor surgery: magnetic resonance imaging-based study.
        Oncology. 2010; 78: 115-124
        • Leschinger T.
        • Müller L.P.
        • Hackl M.
        • Scaal M.
        • Schmidt-Horlohé K.
        • Wegmann K.
        Concomitant injury of the annular ligament in fractures of the coronoid process and the supinator crest.
        J Shoulder Elbow Surg. 2017; 26: 604-610
        • Moon J.G.
        • Bither N.
        • Jeon Y.J.
        • Oh S.M.
        Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up.
        Arch Orthop Trauma Surg. 2013; 133: 1665-1668
        • Morrey B.F.
        • An K.N.
        Articular and ligamentous contributions to the stability of the elbow joint.
        Am J Sports Med. 1983; 11: 315-319
        • Morrey B.F.
        • An K.N.
        Stability of the elbow: osseous constraints.
        J Shoulder Elbow Surg. 2005; 14: 174-178
        • O'Driscoll S.W.
        • Jupiter J.B.
        • Cohen M.S.
        • Ring D.
        • McKee M.D.
        Difficult elbow fractures: pearls and pitfalls.
        Instr Course Lect. 2003; 52: 113-134
        • Pollock J.W.
        • Brownhill J.
        • Ferreira L.
        • McDonald C.P.
        • Johnson J.
        • King G.
        The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics.
        J Bone Joint Surg Am. 2009; 91: 1448-1458
        • Rafehi S.
        • Lalone E.
        • Johnson M.
        • King G.J.
        • Athwal G.S.
        An anatomic study of coronoid cartilage thickness with special reference to fractures.
        J Shoulder Elbow Surg. 2012; 21: 961-968
        • Rahman R.K.
        • Levine W.N.
        • Ahmad C.S.
        Elbow medial collateral ligament injuries.
        Curr Rev Musculoskelet Med. 2008; 1: 197-204
        • Regan W.
        • Morrey B.
        Fractures of the coronoid process of the ulna.
        J Bone Joint Surg Am. 1989; 71: 1348-1354
        • Regan W.D.
        • Korinek S.L.
        • Morrey B.F.
        • An K.N.
        Biomechanical study of ligaments around the elbow joint.
        Clin Orthop Relat Res. 1991; 271: 170-179
        • Rhyou I.H.
        • Kim K.C.
        • Lee J.H.
        • Kim S.Y.
        Strategic approach to O'Driscoll type 2 anteromedial coronoid facet fracture.
        J Shoulder Elbow Surg. 2014; 23: 924-932
        • Rhyou I.H.
        • Lee J.H.
        • Kim K.C.
        • Ahn K.B.
        • Moon S.C.
        • Kim H.J.
        • et al.
        What injury mechanism and patterns of ligament status are associated with isolated coronoid, isolated radial head, and combined fractures?.
        Clin Orthop Relat Res. 2017; 475: 2308-2315
        • Ring D.
        • Doornberg J.N.
        Fracture of the anteromedial facet of the coronoid process. Surgical technique.
        J Bone Joint Surg Am. 2007; 89: 267-283
        • Rueden C.T.
        • Schindelin J.
        • Hiner M.C.
        • DeZonia B.E.
        • Walter A.E.
        • Arena E.T.
        • et al.
        ImageJ2: ImageJ for the next generation of scientific image data.
        BMC Bioinformatics. 2017; 18: 529
        • Sanchez-Sotelo J.
        • O'Driscoll S.W.
        • Morrey B.F.
        Medial oblique compression fracture of the coronoid process of the ulna.
        J Shoulder Elbow Surg. 2005; 14: 60-64
        • Steinmann S.P.
        Coronoid process fracture.
        J Am Acad Orthop Surg. 2008; 16: 519-529
        • Van Der Werf H.J.
        • Guitton T.G.
        • Ring D.
        Non-operatively treated fractures of the anteromedial facet of the coronoid process: a report of six cases.
        Shoulder Elbow. 2010; 2: 40-42
        • Wegmann K.
        • Burkhart K.J.
        • Bingoel A.S.
        • Ries C.
        • Neiss W.F.
        • Müller L.P.
        Anatomic relations between the lateral collateral ligament and the radial head: implications for arthroscopic resection of the synovial fold of the elbow.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 3421-3425