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Inagaki K, Ochiai N, Hashimoto E, Hattori F, Hiraoka Y, Ise S, Shimada Y, Ohtori S. Biomechanical Comparison of Stability and Strength After Ulnar Collateral Ligament Reconstruction With Suture Anchor Fixation Versus Bone Tunnels. Orthop J Sports Med 2023; 11:23259671231196135. [PMID: 37693807 PMCID: PMC10492499 DOI: 10.1177/23259671231196135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/04/2023] [Indexed: 09/12/2023] Open
Abstract
Background Ulnar collateral ligament (UCL) injuries occur frequently in baseball players, and UCL reconstruction is performed when nonoperative treatment fails. Purpose To compare a novel all-suture anchor method of UCL reconstruction with a method using bone tunnels (Ito method) by investigating the displacement against valgus torque and the failure strength. Study Design Controlled laboratory study. Methods Eight fresh-frozen cadaveric upper extremities (mean age, 82.0 years) were utilized in this study. To evaluate the displacement against valgus torque, the valgus stability test was performed for 4 anterior oblique ligament (AOL) conditions: intact AOL, resected AOL, reconstructed using the anchor method, and reconstructed using the Ito method. The load-to-failure test was performed to evaluate the failure strength of the anchor and Ito methods. Displacement against valgus load was compared between conditions using the repeated-measures 2-way analysis of variance with Bonferroni post hoc test, and failure strength between the anchor and Ito methods was compared using the unpaired t test. Results Displacements of the intact AOL and anchor method were significantly greater than those of the resected AOL at both 60° and 90° of flexion (intact AOL: P = .005 and P < .001, respectively; and anchor method: P = .024 and P < .001, respectively). The displacement of the Ito method at 90° of flexion was significantly greater than that of the resected AOL (P = .003), but no significant difference was observed at 60° of flexion (P = .109). There were no significant differences in displacement between the anchor and Ito methods at any flexion angle, nor was there a significant difference in failure torque between the anchor and Ito methods (16.3 ± 3.1 vs 17.6 ± 2.3 N·m, respectively; P = .537). Conclusion The displacement and failure strength against a valgus load after UCL reconstruction using a suture anchor on the ulnar side were equal to those using bone tunnels. Clinical Relevance UCL reconstruction using a suture anchor on the ulnar side is simpler and less invasive than using bone tunnels, with similar outcomes.
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Affiliation(s)
- Kenta Inagaki
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba, Japan
| | - Nobuyasu Ochiai
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba, Japan
| | - Eiko Hashimoto
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba, Japan
| | - Fumiya Hattori
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba, Japan
| | - Yu Hiraoka
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba, Japan
| | - Shohei Ise
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba, Japan
| | - Yohei Shimada
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba, Japan
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Coutinho DV, Fatehi A, Nazzal EM, Baratz ME, Kaufmann RA. Comparing Static Stability of Native Elbow With Static Stability of Novel Bidirectional Ligament Reconstruction at Different Degrees of Elbow Flexion. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
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Kennon JC, Marigi EM, Songy CE, Bernard C, O’Driscoll SW, Sanchez-Sotelo J, Camp CL. Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years. Orthop J Sports Med 2020; 8:2325967120959141. [PMID: 33134400 PMCID: PMC7576921 DOI: 10.1177/2325967120959141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.
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Affiliation(s)
- Justin C. Kennon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Chad E. Songy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Chris Bernard
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Christopher L. Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Christopher L. Camp, MD, Mayo Clinic, 200 First Street SW, Rochester MN 55905, USA () (Twitter: @ChrisCampMD)
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Moon JG, Lee HD. Comparison of Ulnar Collateral Ligament Reconstruction Techniques in the Elbow of Sports Players. Clin Shoulder Elb 2020; 23:41-47. [PMID: 33330233 PMCID: PMC7714322 DOI: 10.5397/cise.2019.00171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/07/2020] [Indexed: 01/25/2023] Open
Abstract
Ulnar collateral ligament injuries have been increasingly common in overhead throwing athletes. Ulnar collateral ligament reconstruction is the current gold standard for managing ulnar collateral ligament insufficiency, and numerous reconstruction techniques have been described. Although good clinical outcomes have been reported regarding return to sports, there are still several technical issues including exposure, graft selection and fixation, and ulnar nerve management. This review article summarizes a variety of surgical techniques of ulnar collateral ligament reconstructions and compares clinical outcomes and biomechanics.
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Affiliation(s)
- Jun-Gyu Moon
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Hee-Dong Lee
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
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Jung HS, Lee JS, Rhyou IH, Lee HW, Park MJ. Dual reconstruction of lateral collateral ligament is safe and effective in treating posterolateral rotatory instability of the elbow. Knee Surg Sports Traumatol Arthrosc 2019; 27:3284-3290. [PMID: 31065772 DOI: 10.1007/s00167-019-05525-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Although reconstruction of the lateral ulnar collateral ligament (LUCL) has been considered the procedure of choice for posterolateral rotatory instability (PLRI), recent studies have reported that the entire lateral collateral ligament complex (LCLC), rather than its posterior part only, contributes to preventing PLRI. Thus, it was hypothesized that dual reconstruction of the radial collateral ligament (RCL) and LUCL for the treatment of elbow PLRI could provide favourable clinical results regardless of the mechanism of injury. METHODS This retrospective study reviewed the clinical results of 21 patients who underwent dual reconstruction of the RCL and LUCL between 2011 and 2016. Functional outcomes were assessed using the numeric rating scale (NRS) score, Mayo Elbow Performance Score (MEPS), quick Disabilities of the Arm, Shoulder, and Hand (quick DASH) score, and manual varus instability. To identify any difference in outcomes according to the aetiologies for LCLC insufficiency, our patients were divided into LCLC insufficiency associated with elbow dislocation and that with lateral epicondylitis. RESULTS At a median follow-up of 27 months (range 13-65 months), all patients showed resolved instability and achieved a functional arc of motion. In addition, lateral pivot shift tests were negative in all patients. The median MEPS significantly improved after surgery from 70 (range 60-75) to 85 (range 75-100) (p < 0.001), while the median quick DASH score improved from 38.6 (range 26.6-54.5) to 11.4 (range 0-34.1) (p < 0.001). Clinical outcomes according to the aetiology of LCLC insufficiency were not significantly different except for the NRS score. CONCLUSION The results suggest that the dual reconstruction technique leads to a clinical outcome similar to that of conventional LUCL reconstruction in LCLC insufficiency regardless of aetiology. In addition, the dual reconstruction technique was technically easier than the conventional LUCL reconstruction technique and may be a potential alternative when a bone tunnel created at the proximal ulna by the original technique has failed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hyoung Seok Jung
- Department of Orthopaedic Surgery, Medical Centre of Chung-Ang University School of Medicine, Seoul, South Korea
| | - Jae Sung Lee
- Department of Orthopaedic Surgery, Medical Centre of Chung-Ang University School of Medicine, Seoul, South Korea
| | - In Hyeok Rhyou
- Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Centre, Pohang SM Christianity Hospital, Pohang, South Korea
| | - Ho Won Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
| | - Min Jong Park
- Department of Orthopaedic Surgery, Samsung Medical Centre, SungKyunKwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Rollo G, Meccariello L, Rotini R, Pichierri P, Bisaccia M, Fortina M. Efficacy of the "Salento technique", a modified two-incision approach in distal biceps brachii tendon repair. Surgical description and outcomes analysis. J Clin Orthop Trauma 2019; 10:959-964. [PMID: 31528075 PMCID: PMC6739296 DOI: 10.1016/j.jcot.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The biceps brachii lesion needs to be treated surgically. A modified two incisions technique is proposed and reviewed. Material and Methods: All patients were treated with the same technique. The outcomes were measured with the Quick-DASH Score (QDS), and the Mayo Elbow Performance Score (MEPS). Postoperative complications and distal biceps tendon strength were registered also. RESULTS At one year from the trauma, the QDS and the MEPS were excellent in all patients. 72.97% fully recovered and returned to work after 6 months from the trauma. DISCUSSION This technique, thanks to its preservation of anatomical structures, provides great outcomes.
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Affiliation(s)
- Giuseppe Rollo
- Orthopedics and Traumatology Department, Vito Fazzi Hospital, Lecce, Italy
| | - Luigi Meccariello
- Orthopedics and Traumatology Department, Vito Fazzi Hospital, Lecce, Italy
| | - Roberto Rotini
- Shoulder and Elbow Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Paolo Pichierri
- Orthopedics and Traumatology Department, Vito Fazzi Hospital, Lecce, Italy
| | - Michele Bisaccia
- Division of Orthopedics and Trauma Surgery, University Hospital of Perugia, Perugia, Italy
| | - Mattia Fortina
- Orthopedics and Traumatology Department, Siena University Hospital, Siena, Italy,Corresponding author. Orthopedics and Traumatology Department, Siena University Hospital, v.le Bracci 14-16, 53100, Siena, Italy.
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Reconstruction of the lateral ulnar collateral ligament of the elbow: a comparative biomechanical study. Knee Surg Sports Traumatol Arthrosc 2017; 25:943-948. [PMID: 25957610 DOI: 10.1007/s00167-015-3627-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Posterolateral rotatory instability (PLRI) of the elbow is the result of an insufficient lateral collateral ligament complex (LCLC). Single-bundle reconstruction of the lateral ulnar collateral ligament (LUCL) represents the standard treatment method for chronic PLRI. However, cases of recurrent instability after LUCL reconstruction have been reported. The dual-reconstruction procedure has been described to anatomically restore the LUCL as well as the radial collateral ligament (RCL). It was hypothesized that anatomic reconstruction of the LCLC provides increased stability compared with the conventional technique. METHODS Posterolateral rotatory displacement was assessed in eight fresh-frozen human elbows with a maximum load of 20 N. Data were obtained in 0°, 30°, 60°, 90° and 120° of elbow flexion for native specimens, dissected LCLC and three reconstruction methods: (1) single-bundle LUCL reconstruction, (2) single-bundle LUCL reconstruction with RCL augmentation, (3) dual-reconstruction technique (LUCL + RCL). RESULTS All reconstruction methods were able to sufficiently restore posterolateral rotatory stability of the elbow over the full range of motion. There were no significant differences between the intact specimens and either reconstruction method. Dissection of the LCLC significantly increased PLRI compared with the other groups (p < 0.001). CONCLUSION The less invasive dual-reconstruction technique is confirmed as a safe procedure for anatomic LCLC reconstruction. Primary stability is equal, yet not superior to conventional LUCL reconstruction. Hence, this biomechanical study does not confirm the hypothesis that more anatomic reconstruction techniques could reduce the risk of recurrent instability when compared to conventional LUCL reconstruction.
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Affiliation(s)
- Brandon J Erickson
- 1Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
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Erickson BJ, Harris JD, Fillingham YA, Cvetanovich GL, Bush-Joseph CA, Bach BR, Romeo AA, Verma NN. Treatment of Ulnar Collateral Ligament Injuries and Superior Labral Tears by Major League Baseball Team Physicians. Arthroscopy 2016; 32:1271-6. [PMID: 27017566 DOI: 10.1016/j.arthro.2016.01.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine practice patterns of Major League Baseball (MLB) team orthopaedic surgeons in addressing the controversial topics of ulnar collateral ligament (UCL) tears, type II SLAP tears, and partial-thickness rotator cuff tear. METHODS Seventy-four MLB team orthopaedic surgeons were surveyed via an online survey system. A 14-question survey was used to assess surgeon experience, technique, and graft choice for UCL reconstruction (UCLR), treatment of type II SLAP tears, and other common pathologic conditions. RESULTS Thirty team orthopaedic surgeons (41%) responded (mean experience as team physicians: 9.37 ± 6.33 years). Seventeen (56.7%) surgeons use the docking technique for UCLR whereas 20% use the modified Jobe technique. Nineteen (63.3%) use palmaris longus autograft in UCLR. Overall, 28 (93.3%) do not routinely perform elbow arthroscopy or perform an obligatory transposition of the ulnar nerve in patients without preoperative ulnar nerve symptoms. Twenty-eight (93.3%) would repair a type II SLAP tear, whereas only 1 (3.3%) would debride the tear. No surgeon would perform a concomitant biceps tenodesis, either open or arthroscopic. CONCLUSIONS Most MLB team orthopaedic surgeons perform a UCLR using the docking technique with a palmaris longus autograft without concomitant elbow arthroscopy or obligatory transposition of the ulnar nerve. The overwhelming majority of these surgeons would also treat an operative type II SLAP tear with a SLAP repair. CLINICAL RELEVANCE The number of UCLRs and SLAP repairs performed on MLB pitchers has significantly increased over the past 10 years. To properly treat these conditions in elite, college, and recreational athletes, it is important to understand how the surgeons who take care of the most elite-level athletes treat them, and how they are able to reproducibly attain excellent outcomes. This study shows how these common shoulder and elbow injuries are treated by those surgeons who care for the most elite overhead-throwing athletes in the world.
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Affiliation(s)
- Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Joshua D Harris
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Yale A Fillingham
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Gregory L Cvetanovich
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Charles A Bush-Joseph
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Abstract
Overhead athletes subject their elbows to significant valgus stresses throughout the throwing cycle. A steady rise in the number of medial-sided elbow injuries over the years has lead to increased awareness regarding the pathophysiology of the "pitcher's elbow." As our understanding of the functional anatomy and throwing biomechanics has become more sophisticated, we have seen a concurrent improvement in the outcomes associated with managing these injuries. Despite this improvement, continued anatomical and biomechanical research is still needed to further optimize outcomes and return to sport.
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Erickson BJ, Bach BR, Cohen MS, Bush-Joseph CA, Cole BJ, Verma NN, Nicholson GP, Romeo AA. Ulnar Collateral Ligament Reconstruction: The Rush Experience. Orthop J Sports Med 2016; 4:2325967115626876. [PMID: 26862538 PMCID: PMC4735505 DOI: 10.1177/2325967115626876] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ulnar collateral ligament reconstruction (UCLR) is a common surgery performed in professional, collegiate, and high school athletes. PURPOSE To report patient demographics, surgical techniques, and outcomes of all UCLRs performed at a single institution from 2004 to 2014. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients who underwent UCLR from January 1, 2004, through December 31, 2014, at a single institution were identified. Charts were reviewed to determine patient age, sex, date of surgery, sport played, athletic level, surgical technique, graft type, and complications. Data were collected prospectively, and patients were contacted via phone calls to obtain the return-to-sport rate, Conway-Jobe score, Andrews-Timmerman score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Continuous variable data were reported as weighted means, and categorical variable data were reported as frequencies with percentages. RESULTS A total of 187 patients (188 elbows) underwent UCLR during the study period (92% male; mean age, 19.6 ± 4.7 years; 78.2% right elbows). There were 165 baseball players (87.8% of all patients), 155 of whom were pitchers (82.5% of all patients). Ninety-seven (51.6%) were college athletes, 68 (36.2%) high school athletes, and 7 (3.7%) professional athletes at the time of surgery. The docking technique was used in 110 (58.5%) patients while the double-docking technique was used in 78 (41.5%). An ipsilateral palmaris longus graft was used in 110 (58.5%) patients while a hamstring autograft was used in 48 (25.5%) patients. The ulnar nerve was subcutaneously transposed in 79 (42%) patients. Clinical follow-up data were available on 85 patients. Mean follow-up was 60 ± 30.8 months. Overall, 94.1% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The mean KJOC score was 90.4 ± 6.7 and mean Andrews-Timmerman score was 92.5 ± 7.1. Subsequent surgeries were performed in 5.3% of patients. CONCLUSION UCLR was performed most commonly on collegiate athletes using an ipsilateral palmaris longus graft. Overall, 94.1% of patients who underwent UCLR were able to return to sport with a mean KJOC score of 90.4 and Andrews-Timmerman Score of 92.5.
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Affiliation(s)
- Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois USA
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois USA
| | - Mark S Cohen
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois USA
| | | | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois USA
| | - Gregory P Nicholson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois USA
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois USA
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Erickson BJ, Chalmers PN, Bush-Joseph CA, Verma NN, Romeo AA. Ulnar Collateral Ligament Reconstruction of the Elbow: A Systematic Review of the Literature. Orthop J Sports Med 2015; 3:2325967115618914. [PMID: 26740956 PMCID: PMC4687831 DOI: 10.1177/2325967115618914] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in both professional and high-level athletes. Purpose: To determine the effect of technique and level of play with UCLR on return to sport (RTS). Hypothesis: When comparing different surgical techniques or preoperative level of sports participation, there is no difference in rate of RTS after UCLR. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting UCLR outcomes with level of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Descriptive statistics were calculated, and 2-proportion 2-sample z-test calculators with α = .05 were used to compare RTS between level of play and technique. Results: Twenty studies (2019 patients/elbows; mean age, 22.13 ± 4 years; 97% male; mean follow-up, 39.9 ± 16.2 months) were included. The majority of patients were baseball players (94.5%), specifically pitchers (80%). The most common level of play was collegiate (44.6%). Palmaris longus (71.2%) and the American Sports Medicine Institute (ASMI) technique (65.6%) were the most common graft choice and surgical technique, respectively. There was a pooled 86.2% RTS rate, and 90% of players scored excellent/good on the Conway-Jobe scale. RTS rates were higher among collegiate athletes (95.5%) than either high school (89.4%, P = .023) or professional athletes (86.4%, P < .0001). RTS rates were higher for the docking technique (97.0%, P = .001) and the ASMI technique (93.3%, P = .0034) than the Jobe technique (66.7%). Conclusion: UCLR is performed most commonly in collegiate athletes. Collegiate athletes have the highest RTS rate after UCLR of all levels of competition. The docking and ASMI techniques had higher RTS rates than the Jobe technique.
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Affiliation(s)
- Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter N Chalmers
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles A Bush-Joseph
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Erickson BJ, Harris JD, Chalmers PN, Bach BR, Verma NN, Bush-Joseph CA, Romeo AA. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Sports Health 2015; 7:511-7. [PMID: 26502444 PMCID: PMC4622381 DOI: 10.1177/1941738115607208] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Context: Ulnar collateral ligament (UCL) injuries lead to pain and loss of performance in the thrower’s elbow. Ulnar collateral ligament reconstruction (UCLR) is a reliable treatment option for the symptomatic, deficient UCL. Injury to the UCL usually occurs because of chronic accumulation of microtrauma, although acute ruptures occur and an acute-on-chronic presentation is also common. Evidence Acquisition: Computerized databases, references from pertinent articles, and research institutions were searched for all studies using the search terms ulnar collateral ligament from 1970 until 2015. Study Design: Clinical review. Level of Evidence: Level 5. Results: All studies reporting outcomes for UCLR are level 4. Most modern fixation methodologies appear to be biomechanically and clinically equivalent. Viable graft choices include ipsilateral palmaris longus tendon autograft, gracilis or semitendinosus autograft, and allograft. Clinical studies report excellent outcomes of UCLR for both recreational and elite level athletes with regard to return to sport and postoperative performance. Complications, although rare, include graft rerupture or attenuation, ulnar nerve symptoms, stiffness, pain, and/or weakness leading to decreased performance. Conclusion: Injuries to the UCL have become commonplace among pitchers. Nonoperative treatment should be attempted, but the limited studies have not shown promising results. Operative treatment can be performed with several techniques, with retrospective studies showing promising results. Complications include ulnar neuropathy as well as failure to return to sport. Detailed preoperative planning, meticulous surgical technique, and a comprehensive rehabilitation program are essential components to achieving a satisfactory result.
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Affiliation(s)
- Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | - Joshua D Harris
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas Weill Cornell College of Medicine, New York, New York
| | - Peter N Chalmers
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | | | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
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Lynch JL, Pifer MA, Maerz T, Kurdziel MD, Davidson AA, Baker KC, Anderson K. The GraftLink ulnar collateral ligament reconstruction: biomechanical comparison with the docking technique in both kinematics and failure tests. Am J Sports Med 2013; 41:2278-87. [PMID: 23940203 DOI: 10.1177/0363546513498999] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) reconstruction aims to restore valgus stability, and numerous techniques have been described in the literature. HYPOTHESIS/ PURPOSE: To biomechanically compare the GraftLink (GL) technique with traditional bone tunnels used in the docking (DO) technique. It is hypothesized that the GL method will offer a stiffer, less lax construct compared with the DO. STUDY DESIGN Controlled laboratory study. METHODS Native and reconstructed states were tested in 7 matched pairs of cadaveric arms. To test kinematics, a 1.5-N·m valgus torque was applied and the resultant displacement at 15° to 90° of flexion was measured. Dissipated energy and the torque at the peak of the 10th cycle of preconditioning were analyzed during kinematic tests. Failure testing was performed by internal rotation of the humerus at 4.5 deg/s in 70° of flexion. Ulnotrochlear joint (UTJ) gapping was quantified during failure tests by use of video tracking. RESULTS Kinematics testing revealed no differences between the native state and the reconstructed state in either the DO or the GL group at any flexion angle. Stiffness was lower in the reconstructed specimens in both the DO (39.92 N·m/rad) and GL (50.74 N·m/rad) groups compared with their matched native states (DO Native, 71.41 N·m/rad, P = .005; GL Native, 86.36 N·m/rad, P = .002). There was no difference in stiffness between DO and GL. Reconstructed specimens in the GL group had lower torque at failure compared with native specimens (17.404 N·m vs 24.63 N·m, P = .038), but there was no difference in the DO group at failure. There was no difference in torque at failure between DO and GL. The DO exhibited higher angular displacement at failure compared with the native state (34.21° vs 21.79°, P = .010) and compared with the GL when normalized (1.58-fold vs 1.19-fold, P = .039). Compared with their native states, both DO and GL had significantly higher UTJ gapping at 3 N·m and at failure. The DO had significantly higher normalized UTJ gapping than the GL at 3 N·m (P = .037) and at failure (P = .043). CONCLUSION The DO and GL both restored joint kinematics under low loading conditions. Although less stiff, the GL exhibited lower joint gapping and laxity than did the DO. CLINICAL RELEVANCE Understanding the biomechanics of UCL reconstruction has significant implications for postoperative management as it relates to early rehabilitation. Biomechanically inferior constructs could risk graft failure or early loosening during rehabilitation, and comparing the biomechanics of new techniques to established, widely used procedures such as the docking technique can provide important information about the immediate postoperative performance.
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Affiliation(s)
- Jamie L Lynch
- Kevin Baker, Beaumont Research Institute, 3811 W 13 Mile Rd, Suite 404, Royal Oak, MI 48073.
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Lynch JL, Maerz T, Kurdziel MD, Davidson AA, Baker KC, Anderson K. Biomechanical evaluation of the TightRope versus traditional docking ulnar collateral ligament reconstruction technique: kinematic and failure testing. Am J Sports Med 2013; 41:1165-73. [PMID: 23636555 DOI: 10.1177/0363546513482567] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous variations of ulnar collateral ligament (UCL) reconstruction have been described since the original technique by Jobe et al. Purpose/ HYPOTHESIS To biomechanically compare the new TightRope technique and the traditional ulnar bone tunnels as used in the docking technique. The hypothesis was that the TightRope technique would exhibit improved kinematics and comparable failure properties. STUDY DESIGN Controlled laboratory study. METHODS Seven matched pairs of cadaveric arms (mean age, 44.71 years) were tested in both the native state and reconstructed state. Kinematics were assessed at 15° to 90° of flexion by applying a 1.5-N·m valgus torque and measuring the resultant angular displacement. Failure testing was performed by loading to failure at 4.5 deg/s in 70° of flexion. Sides of a matched pair were randomized to the TightRope (TR) and docking (DO) techniques after testing the native state. RESULTS There was no significant difference in kinematic results between the native state and reconstructed state in either the TR or DO group at 15° to 75° of flexion. At 90°, the TR group had significantly higher angular displacement (2.23° ± 1.0°) compared with the native state (1.31° ± 0.7°) (P = .020). The TR-reconstructed specimens had significantly lower initial stiffness (49.34 ± 19.3 N·m/rad vs 82.47 ± 36.0 N·m/rad, respectively; P = .007) and total stiffness (53.81 ± 27.8 N·m/rad vs 101.06 ± 34.4 N·m/rad, respectively; P < .001) than did the paired native specimens. In addition, the TR-reconstructed specimens had significantly lower torsional torque at 5° of valgus rotation (mean, 4.61 ± 2.2 N·m vs 7.62 ± 3.7 N·m, respectively; P = .010), at 15° of valgus rotation (12.24 ± 4.4 N·m vs 20.65 ± 6.8 N·m, respectively; P = .002), and at ultimate failure (19.18 ± 7.5 N·m vs 25.42 ± 7.1 N·m, respectively; P = .025) than did the paired native specimens. There was no significant difference in torsional torque between the TR and DO groups at 5° of valgus rotation (4.61 ± 2.2 N·m vs 4.09 ± 1.7 N·m, respectively; P = .644), at 15° of valgus rotation (12.24 ± 4.4 N·m vs 17.94 ± 7.23 N·m, respectively; P = .178), or at failure (19.18 ± 7.5 N·m vs 23.19 ± 10.6 N·m, respectively; P = .444). The DO group exhibited significantly higher angular displacement at failure than did the native state (28.12° ± 8.5° vs 18.04° ± 4.8°, respectively; P = .009), but there was no difference at 3 N·m of loading. There was no significant difference in angular displacement either at 3 N·m or at failure between the native state and reconstructed state in the TR group. CONCLUSION Both the TR and DO techniques restored native joint kinematics from 15° to 75° of flexion under low loading conditions. While the TR technique exhibited inferior failure torque compared with the native state, the DO technique did not differ from the native state. No differences were found between the TR and DO groups when compared directly. The DO technique restored valgus stability under high loading to a greater extent than did the TR technique but also failed at higher angular displacement. CLINICAL RELEVANCE Strong postoperative UCL reconstruction fixation is important to restore ulnotrochlear joint stability. Our study demonstrates that the new TR technique has comparable kinematic and failure properties to the traditional DO technique.
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Affiliation(s)
- Jamie L Lynch
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI 48703, USA
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