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Campbell L, Bryan TP, Edmonds EW. Intermediate Outcomes of Medial Ulnar Collateral Ligament Reconstruction Using Gracilis Allograft in Adolescent Patients. Orthop J Sports Med 2024; 12:23259671241228868. [PMID: 38449693 PMCID: PMC10916473 DOI: 10.1177/23259671241228868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 03/08/2024] Open
Abstract
Background Autograft palmaris has been the primary choice for the reconstruction of the medial ulnar collateral ligament (UCL) in the elbow. Agenesis of the palmaris tendon is not rare, and outcomes of allograft reconstruction in the breadth of athlete types found in the adolescent population are lacking. Hypothesis Allograft tendon reconstruction of the medial UCL in the young elbow would have low failure rates and satisfactory outcome scores. Study Design Case series; Level of evidence, 4. Methods The records of patients who underwent allograft medial UCL reconstruction (UCLR) by a single surgeon between 2009 and 2019 were reviewed. Patient-reported outcome scores in adolescent patients obtained at a minimum 4-year follow-up (for intermediate assessment) were recorded, with no exclusion according to sex or sport type. Outcomes included the Timmerman-Andrews score, the Single Assessment Numeric Evaluation (SANE), and the Conway-Jobe score. Results Of 29 patients who underwent allograft UCLR, 10 adolescents (40% women; mean age at surgery, 15.8 years [age range, 15-17 years]) met the inclusion criteria and were included in the study. The mean follow-up was 8 years (range, 4.3-11.9 years). There were 4 overhead athletes (baseball, water polo) and 6 impact sports athletes (motocross, gymnastics, wrestling, and soccer). The mean SANE score was 86.3, and the mean subjective Timmerman-Andrews score was 92.5. The Conway-Jobe score was "excellent" in 7 of 10 participants; nonetheless, 3 elected not to return to sport (2 for reasons unrelated to the elbow). No patients experienced loss of range of motion, contracture, or ulnar nerve neuropathy. There was 1 patient with early failure (10%) who required revision reconstruction . Conclusion Allograft reconstruction for medial UCL instability in adolescent patients from sport and trauma mechanisms demonstrated excellent patient-reported functional scores in this study. If the patient and surgeon desire to avoid autograft morbidity or agenesis of the palmaris longus, allograft tendon UCLR appears viable for both the throwing and the high-impact adolescent athlete, regardless of sex.
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Affiliation(s)
- Leonie Campbell
- Department of Orthopaedic Surgery, Balboa Naval Medical Center, San Diego, California, USA
| | - Tracey P. Bryan
- Division of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Eric W. Edmonds
- Division of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA
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Stone MA, Chao L, Huang DT, Parikh HB, Sun M, Kulber DA, Metzger MF. Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction Between Palmaris Longus Autograft and Knee Medial Collateral Ligament Allograft. Orthop J Sports Med 2024; 12:23259671241234685. [PMID: 38524888 PMCID: PMC10958818 DOI: 10.1177/23259671241234685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/07/2023] [Indexed: 03/26/2024] Open
Abstract
Background Medial ulnar collateral ligament (mUCL) injury can cause significant pain and alter throwing mechanics. Common autograft options for mUCL reconstruction (UCLR) include the palmaris longus (PL) and hamstring tendons. Allograft use may reduce donor site morbidity and decrease function related to PL autografts. Purpose To compare varus stability and load to failure between a novel allograft for UCLR-knee medial collateral ligament (kMCL)-and a PL autograft in human donor elbow specimens. Study Design Controlled laboratory study. Methods A total of 24 fresh-frozen human elbows were dissected to expose the mUCL. Medial elbow stability was tested with the mUCL intact (native), deficient, and reconstructed utilizing the humeral single-docking technique with either a (1) kMCL allograft (n = 12) or (2) a PL autograft (n = 12). A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion tracking cameras. The elbow was cycled through a full range of motion 5 times. After kinematic testing, specimens were loaded to failure at 70° of elbow flexion, and failure modes were recorded. Results The mUCL-deficient elbows demonstrated significantly greater valgus rotation compared with the intact and reconstructed elbows at every flexion angle tested (10°-120°) (P <.001). Both kMCL- and PL-reconstructed elbows exhibited significantly higher mean valgus rotation compared with the intact state between 10° and 40° of flexion (P < .01). There were no significant differences in valgus rotation at any flexion angle between the kMCL and PL graft groups. When loaded to failure, elbows reconstructed with both kMCL and PL grafts failed at similar torque values (18.6 ± 4 and 18.1 ± 3.4 N·m, respectively; P = .765). Conclusion Fresh-frozen and aseptically processed kMCL allografts demonstrated similar kinematic and failure properties to PL tendon autografts in UCL-reconstructed elbows, although neither graft fully restored kinematics between 10° and 40°. Clinical Relevance Prepared kMCL ligament allografts may provide a viable graft material when reconstructing elbow ligaments while avoiding the potential complications related to PL autografts- including donor site morbidity.
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Affiliation(s)
- Michael A. Stone
- Cedars-Sinai, Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Linda Chao
- Cedars-Sinai, Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Dave T. Huang
- Cedars-Sinai Orthopaedic Biomechanics Laboratory, Los Angeles, California, USA
| | - Harin B. Parikh
- Cedars-Sinai, Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Michael Sun
- Cedars-Sinai, Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - David A. Kulber
- Cedars-Sinai, Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Melodie F. Metzger
- Cedars-Sinai, Department of Orthopaedic Surgery, Los Angeles, California, USA
- Cedars-Sinai Orthopaedic Biomechanics Laboratory, Los Angeles, California, USA
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Sachinis NP, Beitzel K, Moya D, Gomez D, Koukos C. Bracing with Tape and Extensor Refixation of Elbow with Posterolateral Instability Due to Cubitus Varus: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00027. [PMID: 37943969 DOI: 10.2106/jbjs.cc.22.00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
CASE A 54-year-old patient had lateral ligament insufficiency due to cubitus varus from a childhood supracondylar fracture. Arthrolysis/synovectomy and at a later stage double-row extensor origin refixation and lateral ulnar collateral ligament bracing with nonabsorbent tape and anchors were performed. Follow-up at 3, 6, 12, and 24 months showed excellent Mayo Elbow Performance and Disabilities of Arm, Shoulder, and Hand Scores (24-month follow-up = 100 and 2.5, respectively). CONCLUSION Suture tape augmentation and double-row extensor refixation in cases of lateral collateral ligament complex insufficiency due to cubitus varus may provide improved short-term functional outcomes, from the third postoperative month.
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Affiliation(s)
- Nikolaos Platon Sachinis
- First Orthopaedic Department, "Georgios Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Knut Beitzel
- Shoulder Institute, ATOS Orthoparc Klinik, Cologne, Germany
| | - Daniel Moya
- Department of Orthopaedic Surgery, Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Diego Gomez
- Department of Orthopaedic Surgery, Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Christos Koukos
- Special sports surgery department, St. Josef Krankenhaus, Wuppertal, Germany
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4
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Sachinis NP, Yiannakopoulos CK, Beitzel K, Koukos C. Arthroscopic Modified Elbow Lateral Collateral Ligament Imbrication: An Operative Technique. Arthrosc Tech 2023; 12:e709-e714. [PMID: 37323785 PMCID: PMC10265613 DOI: 10.1016/j.eats.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/19/2023] [Indexed: 06/17/2023] Open
Abstract
When the lateral collateral ligament (LCL) complex fails to support the radiocapitellar and ulnohumeral joints in advanced stages of insufficiency, the patient experiences posterolateral rotatory instability (PLRI). Open lateral ulnar collateral ligament repair with a ligamentous graft has been the standard treatment for PLRI. Despite producing good clinical stability rates, this method is associated with significant lateral soft-tissue dissection and a lengthy recovery period. By fastening the LCL to its humeral insertion, arthroscopic imbrication of the LCL can increase stability. The senior author modified this technique. With the aid of a passer, the LCL complex, lateral capsule, and anconeus may be weaved with a single (doubled) suture, secured with a Nice knot. LCL complex imbrication may be used to restore stability and improve pain and function in patients with grade I and II PLRI.
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Affiliation(s)
- Nikolaos Platon Sachinis
- First Orthopaedic Department of Aristotle University of Thessaloniki, “Georgios Papanikolaou” Hospital, Thessaloniki, Greece
| | - Christos K. Yiannakopoulos
- Iaso Hospital, Athens, Greece
- School of Physical Education and Sports Science, National & Kapodistrian University of Athens, Athens, Greece
| | - Knut Beitzel
- Shoulder Institute, ATOS Orthoparc Klinik, Cologne, Germany
| | - Christos Koukos
- Special Sports Surgery Department, St. Josef Krankenhaus, Wuppertal, Germany
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5
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Chanlalit C, Mahasupachai N, Sakdapanichkul C. Arthroscopic lateral collateral ligament imbrication for treatment of atraumatic posterolateral rotatory instability. J Orthop Surg (Hong Kong) 2022; 30:10225536221113243. [PMID: 35790113 DOI: 10.1177/10225536221113243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Among the causative lesions of lateral elbow pain, atraumatic posterolateral rotatory instability (PLRI) is a rare condition, but it produces pain and disability to the elbow. It still lacks published specific treatment literature. According to the development of arthroscopy, the arthroscopic lateral collateral ligament (LCL) imbrication can possibly be an alternative minimal invasive procedure that can eradicate the atraumatic PLRI. Hypothesis/Purpose: To report clinical results of arthroscopic LCL imbrication for the treatment on atraumatic PLRI elbow. Methods: Thirty-three patients with chronic atraumatic lateral elbow pain were presented to our institution between July 2015 and December 2021. Eight patients were diagnosed with atraumatic PLRI and underwent arthroscopic LCL imbrication. Comparison between the pre- and post-operative scores were recorded, which were The Quick-Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score, Mayo Elbow Performance Index (MEPI) and Visual Analog Scale for pain (VAS). Results: Mean follow-up was 16 months (9-24 months). Comparing between pre-operation and post-operation, all of eight patients had significant improved Quick-DASH score (mean 55.62 vs 7.62, p = .004), MEPI (mean 50.00 vs 96.87, p = .000) and VAS for pain (mean 8.14 vs 1.28, p = .000). Conclusion: Atraumatic PLRI is a concerning lesion in patients with lateral elbow pain. Arthroscopic LCL imbrication can be simultaneously performed with other lateral elbow pain causations, such as tennis elbow and pathological plica, and provide painless, stable, and functional elbow. LEVEL OF EVIDENCE Case Series (Level of evidence: 4).
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Affiliation(s)
- Cholawish Chanlalit
- Center of Excellent in Upper Extremity Reconstruction and Sports Medicine, Department of Orthopaedics, HRH Princess Maha Chakri Sirindhorn Medical Center, 37692Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Nattakorn Mahasupachai
- Center of Excellent in Upper Extremity Reconstruction and Sports Medicine, Department of Orthopaedics, HRH Princess Maha Chakri Sirindhorn Medical Center, 37692Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Chidchanok Sakdapanichkul
- Center of Excellent in Upper Extremity Reconstruction and Sports Medicine, Department of Orthopaedics, HRH Princess Maha Chakri Sirindhorn Medical Center, 37692Srinakharinwirot University, Nakhon Nayok, Thailand
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6
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Schoch C, Dittrich M, Seilern Und Aspang J, Geyer M, Geyer S. Autologous triceps tendon graft for LUCL reconstruction of the elbow: clinical outcome after 7.5 years. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1111-1118. [PMID: 34363106 DOI: 10.1007/s00590-021-03081-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The objective of this study was to assess mid- to long-term functional outcomes in patients treated for symptomatic posterolateral instability of the elbow (PLRI) using an autologous ipsilateral triceps tendon as graft. METHODS A total of 196 patients were treated with autologous triceps tendon graft for symptomatic PLRI at single orthopedic institution from 2006 to 2013. The surgical treatment contained arthroscopic instability testing, reconstruction of the lateral ulnar collateral ligament (LUCL) and harvesting autologous ipsilateral triceps tendon as graft. The follow-up outcomes included range of motion (ROM), pain measured on a visual analogue scale (VAS), Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES) and ultrasound to evaluate the integrity of the refixation of the common extensor. RESULTS A total of 178 patients (female: 73; male: 105) were available for follow-up at a mean of 91 months (range 48-144). No patient reported pain at rest; VAS during activity was 1.8 (range 0-5). The ROM decreased slightly compared to preoperative measurements. Flexion decreased significantly from 135.4 to 131.1, though still within the functional arc of motion. All but 13 patients (8.5%) were clinically stable. However, only two patients received a revision of the LUCL reconstruction due to subjective instability. The mean MEPS in the final follow-up was 91.3 (range 73-100). The mean OES was 46.5 (range 39-48). Three patients reported a pain-free clicking of the elbow. No patient complained about donor site morbidity of the ipsilateral triceps tendon. Ultrasound evaluation showed integrity of the common extensors in all patients. CONCLUSIONS LUCL reconstruction using the ipsilateral triceps tendon as graft shows good to excellent mid- to long-term results in the treatment of symptomatic posterolateral elbow joint instability with a low re-instability and complication rate.
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Affiliation(s)
- Christian Schoch
- St. Vinzenz Klinik Pfronten GmbH, Kirchweg 15, 87459, Pfronten, Germany.
| | - Michael Dittrich
- St. Vinzenz Klinik Pfronten GmbH, Kirchweg 15, 87459, Pfronten, Germany
| | | | - Michael Geyer
- St. Vinzenz Klinik Pfronten GmbH, Kirchweg 15, 87459, Pfronten, Germany
| | - Stephanie Geyer
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
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7
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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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8
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Flanigan DC, Shemory S, Lundy N, Stitgen M, Long JM, Magnussen RA. Medial patellofemoral ligament reconstruction with allograft versus autograft tissue results in similar recurrent dislocation risk and patient-reported outcomes. Knee Surg Sports Traumatol Arthrosc 2020; 28:2099-2104. [PMID: 32185451 DOI: 10.1007/s00167-020-05920-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/24/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine the rate of recurrent dislocation and patellar instability following medial patellofemoral ligament (MPFL) reconstruction with allograft or autograft tissue and compare patient-reported outcomes for patients undergoing allograft and autograft MPFL reconstruction. METHODS One hundred and fifteen MPFL reconstructions (78 allograft, 37 autograft) without concurrent bony procedures performed between 2008 and 2014 by four sports medicine fellowship-trained orthopedic surgeons at our center were identified. Patient demographics and surgical data were identified by chart review. Chart review and patient interviews were undertaken to identify recurrent patellar dislocations and as recurrent subjective patellofemoral instability. Recurrent dislocation and subjective instability risk were compared between the allograft and autograft groups. RESULTS Eighty-seven patients (76%) with complete baseline data and minimum 1-year follow-up were contacted at a mean of 4.1 years following isolated MPFL reconstruction, including 57 patient with allograft reconstructions and 30 with autograft reconstructions. No significant differences in patient sex, age at reconstruction, body mass index, or time to follow-up were noted between groups. Recurrent dislocation occurred in 2 patients in the allograft group (3.5%) and 1 patient in the autograft group (3.3%), (n.s.). Recurrent subjective instability occurred in 17 patients in the allograft group (28.9%) and 11 patients in the autograft group (36.7%), (n.s.). No significant differences in patient-reported outcomes were noted between groups. CONCLUSION The use of either allograft or autograft tissue for MPFL reconstruction results in low (< 3%) risk of recurrent patellar dislocation. Risk of recurrent subjective instability is higher but is similar for both graft types. Surgeons can utilize either graft choice at their discretion without anticipating a significant impact of graft choice on patient outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- David C Flanigan
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA
| | - Scott Shemory
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA
| | - Nathaniel Lundy
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA
| | - Michael Stitgen
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA
| | - Joseph M Long
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA.
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA.
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Surgical Treatment of a Medial Clavicle Fracture Nonunion with Medial Clavicle Resection and Stabilization to the Sternum with Palmaris Longus Graft. Case Rep Orthop 2019; 2019:7123790. [PMID: 31781454 PMCID: PMC6855021 DOI: 10.1155/2019/7123790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/09/2019] [Accepted: 10/05/2019] [Indexed: 11/17/2022] Open
Abstract
Medial end clavicular fractures are a rare occurrence. While most of these fractures can be appropriately managed with a nonoperative treatment, some cases of symptomatic nonunion might be surgically addressed to preserve sternoclavicular joint stability and ensure favorable outcomes. The open reduction and osteosynthesis procedure is a commonly performed procedure to treat clavicular fracture nonunion. However, few revision procedures have been described to address the occasional cases of hardware failure or recurrent nonunion of the medial end. In this report, the authors present a case of symptomatic nonunion of the medial clavicle initially treated with osteosynthesis. Implant failure with hardware migration was then treated by medial clavicle resection and stabilization to the sternum using a palmaris longus autograft and the figure-of-eight lacing technique. Excellent functional outcomes at three years of follow-up were obtained. To the authors' knowledge, this is the first case reporting on a sternoclavicular stabilization with a tendon autograft for such an important bone deficit.
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10
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Aminata IW, Efar TS, Canintika AF. Chronically unreduced elbow dislocation treated with box-loop ligament reconstruction: The first case series. J Clin Orthop Trauma 2019; 10:S123-S126. [PMID: 31695270 PMCID: PMC6823743 DOI: 10.1016/j.jcot.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Describing our initial experience of performing box-loop ligament reconstruction in patients with chronically unreduced elbow dislocation. DESIGN Retrospective review. SETTING One tertiary referral centre. PATIENTS/PARTICIPANTS Six patients treated with box-loop ligament reconstruction from 2015 to 2018 were included in this study. INTERVENTION Box-loop ligament reconstruction. MAIN OUTCOME MEASUREMENT Quick disabilities of the arm, shoulder and hand (Q-DASH) and Mayo elbow performance index (MEPI) score. RESULTS All subjects exhibited substantial increase of range of flexion-extension motion of the affected elbow, from a mean of 24.2° initially to 119.2° postoperatively during the follow-up period (median = 14 months, range 12-31 months). The subjects recorded an average MEPI score of 82.5 points, and average Q-DASH score of 16.2 points. There were no complications that occurred. CONCLUSIONS This is the first case series of patients with chronically unreduced elbow dislocation treated with box-loop ligament reconstruction. Using this technique, all subjects had excellent outcome without any complication. Further studies with larger samples and better methodology are required to investigate the safety and efficacy of such technique.
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Affiliation(s)
- Iman Widya Aminata
- Department of Orthopaedics and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Toto Suryo Efar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
- Corresponding author.
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11
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Wang KK, Boyce G, Peters T, Anderson H, Hoy G. Efficacy of Primary Repair in Professional Athletes with Chronic Radial Collateral Ligament Injuries of Thumb Metacarpophalangeal Joint. J Hand Surg Asian Pac Vol 2019; 24:138-143. [PMID: 31035879 DOI: 10.1142/s2424835519500176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Management of grade III injuries of the radial collateral ligament (RCL) of the thumb is controversial. These injuries are often treated with early surgery. However, early surgery may not be practical for the professional athlete. We report on the outcome of delayed primary repair of chronic RCL injuries without the use of tendon grafts or tendon transfers. Methods: Twelve elite professional athletes with 15 soft tissue RCL injuries who underwent delayed surgery (greater than 6 weeks) were included in this study. Athletes were managed with splinting and ongoing play during the sporting season, and underwent surgery at the conclusion of the season. Mean duration from injury to surgery was 5 months. Mean follow-up was 4.2 years after surgery. Patient-report outcome measures including pain, satisfaction rating, and disability of the arm, shoulder and hand (DASH) scores were collected. Examination findings including range of motion, laxity, and grip and pinch strength were also measured. Return-to-play data were collected for all athletes. Results: The RCL was able to be primarily repaired with suture anchors in all cases. All twelve patients were able to return to competitive play at the same pre-injury professional level. Post-operative joint function such as range of motion and laxity were comparable to the unaffected contralateral side, as were grip and lateral pinch strengths. Tip-pinch strength is lower compared to the unaffected side, but is comparable to age and sex-matched reference group. Conclusions: Delayed primary repair of the RCL is a viable option and results in satisfactory long-term outcomes. This option may be more preferable to the professional athlete who wishes to avoid surgery during the sporting season.
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Affiliation(s)
- Kemble K Wang
- * Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia
| | - Glenn Boyce
- * Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia
| | - Tracy Peters
- * Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia
| | - Hamish Anderson
- * Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia
| | - Greg Hoy
- * Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia.,† Department of Orthopaedic Surgery, Austin Hospital, Melbourne, Australia.,‡ Department of Surgery, Monash University, Melbourne, Australia
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12
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Molenaars RJ, Schoolmeesters BJA, Viveen J, The B, Eygendaal D. There is a role for allografts in reconstructive surgery of the elbow and forearm. Knee Surg Sports Traumatol Arthrosc 2019; 27:1840-1846. [PMID: 30341449 DOI: 10.1007/s00167-018-5221-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/15/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Allografts play an important role in tendon, ligament, and bone reconstruction surgery, particularly when suitable available autologous tissue is limited. Enthusiasm for the use of allografts in reconstructive orthopedic surgery has increased over the past decade, with an increase in allograft use in a variety of procedures. The purpose of this review is to provide an overview of the various applications and indications for the use of allografts in reconstructive surgical procedures of the elbow and forearm. METHODS MEDLINE/PubMed was searched from 1990 through October 2018 for studies on tendon and bony allografts in elbow and forearm reconstructive surgery. RESULTS The Achilles tendon allograft is the most frequently used tendinous allograft, predominantly used in distal biceps and triceps reconstruction. Although reconstruction of the ulnar collateral ligament of the elbow is generally performed using autografts, it has been shown that semitendinosus and gracilis allografts may be equally effective. Extensor hallucis longus allografts are recommended for reconstruction of the lateral collateral ligaments in patients with posterolateral rotatory instability, and there may be a role for osteochondral allograft transplantation in capitellar osteochondral defects. In addition, the use of allografts in reconstruction of the interosseous membrane and various bone pathologies (fractures, bone tumors, forearm nonunions) has been described in current literature. CONCLUSION There is a large variety of pathology and procedures involving the use of various types of allografts in orthopedic reconstructive surgery of the elbow and forearm.
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Affiliation(s)
- R J Molenaars
- Sports Medicine Center, Harvard Medical School at Massachusetts General Hospital, 175 Cambridge St, 4th Floor, Boston, MA, 02114, USA. .,Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - J Viveen
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - B The
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - D Eygendaal
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
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13
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Primeau T, Beauchamp-Chalifour P, Pelet S. Complex Case of Open Fracture-Dislocation of the Elbow. Case Rep Orthop 2019; 2019:3495742. [PMID: 31214371 PMCID: PMC6535853 DOI: 10.1155/2019/3495742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/28/2019] [Indexed: 11/17/2022] Open
Abstract
Complex elbow instability is difficult to surgically address. Careful consideration of the fractures and soft tissue injuries is required. We present the case of a patient who sustained an open fracture-dislocation of the elbow with significant loss of the external humeral condyle and partial loss of the olecranon. He was surgically treated with an iliac crest tricortical autograft fixed with a buttress plate and a lag screw. His lateral ulnar collateral ligament was reconstructed with tendinous autograft collected from his third and fourth extensor digitorum longus tendons. While the procedure complicated with a Nocardia infection and wound breakdown, the patient almost had full range of motion without instability at 11 months of follow-up.
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Affiliation(s)
- Tommy Primeau
- Centre de Recherche FRQS du CHU de Québec—Hôpital Enfant-Jésus, 1401, 18ème Rue, (Québec), Québec, Canada G1J 1Z4
- Department of Orthopedic Surgery, CHU de Québec—Hôpital Enfant-Jésus, 1401, 18ème Rue, (Québec), Québec, Canada G1J 1Z4
| | - Philippe Beauchamp-Chalifour
- Centre de Recherche FRQS du CHU de Québec—Hôpital Enfant-Jésus, 1401, 18ème Rue, (Québec), Québec, Canada G1J 1Z4
- Department of Orthopedic Surgery, CHU de Québec—Hôpital Enfant-Jésus, 1401, 18ème Rue, (Québec), Québec, Canada G1J 1Z4
| | - Stéphane Pelet
- Centre de Recherche FRQS du CHU de Québec—Hôpital Enfant-Jésus, 1401, 18ème Rue, (Québec), Québec, Canada G1J 1Z4
- Department of Orthopedic Surgery, CHU de Québec—Hôpital Enfant-Jésus, 1401, 18ème Rue, (Québec), Québec, Canada G1J 1Z4
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14
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Nordin JS, Olsson O, Lunsjö K. The gracilis tendon autograft is a safe choice for orthopedic reconstructive procedures: a consecutive case series studying the effects of tendon harvesting. BMC Musculoskelet Disord 2019; 20:138. [PMID: 30927929 PMCID: PMC6441161 DOI: 10.1186/s12891-019-2520-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/21/2019] [Indexed: 01/31/2023] Open
Abstract
Background The gracilis tendon is commonly used as an autograft to reconstruct torn tendons or ligaments in many parts of the body. Little is known about the subjective and functional outcome after gracilis tendon harvest. The aim of this study was to evaluate the outcome of the donor leg in patients undergoing such surgery. Methods Patients with chronic acromioclavicular joint dislocations undergoing coracoclavicular ligament reconstructions using autogenous gracilis tendon grafts were eligible for this study. The graft harvesting procedure was carried out in a standard fashion using a tendon stripper. Knee injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and after 12 months. The first 5 patients were included retrospectively and lacked preoperative data, for these patients age- and gender matched normative KOOS scores were used as baseline values. Isometric knee flexor strength in 60° and 90° degrees of flexion was measured at final follow up at a median of 26 (14–56) months postoperatively with the non-operated leg used as reference. Results Twenty four patients were eligible for the study and 2 were excluded. The 22 patients available for analysis had a mean age of 44 (22–62) years at the time of surgery and 4 were women. There was no statistically significant change in KOOS 12 months postoperatively compared to baseline values but the patients were weaker in knee flexion in the operated leg compared to the non-operated one. Conclusions Gracilis tendon harvesting results in a weakness of knee flexion but does not impair subjective knee function and is a procedure that can be recommended when an autogenous tendon graft is needed.
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Affiliation(s)
- Jonas S Nordin
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden. .,Faculty of Medicine, Lund University, Lund, Sweden.
| | - Ola Olsson
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.,Faculty of Medicine, Lund University, Lund, Sweden
| | - Karl Lunsjö
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.,Faculty of Medicine, Lund University, Lund, Sweden
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15
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Elbow flexion angle during graft fixation for ulnar collateral ligament reconstruction: a systematic review of outcomes and complications. J Shoulder Elbow Surg 2018; 27:2284-2291. [PMID: 30318276 DOI: 10.1016/j.jse.2018.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/14/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The ulnar collateral ligament (UCL) of the elbow is commonly injured in overhead athletes, especially baseball pitchers. UCL reconstruction has shown good outcomes regarding return to play, but revision rates are on the rise. This review was conducted to determine the effect of elbow flexion angle during graft fixation on outcomes and complications after UCL reconstruction. METHODS MEDLINE, Embase, and PubMed were searched from database inception to November 16, 2017. Patient demographics, surgical technique, graft selection, outcomes, and complications were extracted from the included studies. The quality of each study was assessed in duplicate with the Methodological Index for Non-Randomized Studies criteria. Descriptive statistics are presented. RESULTS Six studies, with a total of 1168 patients, were included, and all were case series. Excellent Conway scores were present in 83.8% of patients for the 0° to 30° group and in 91.1% of patients for the 45° to 70° group, with no significant differences in return to play between the groups. The rate of revision UCL reconstruction was significantly higher with graft fixation at 0° to 30° (1.4%) compared with fixation at 45° to 70° (0%; P < .01). CONCLUSIONS Elbow flexion angle during graft fixation may not influence return to the same or higher level of competition but appears to influence the need for a revision after UCL reconstruction. However, the available current evidence possesses a high degree of fragility, and further studies are needed with objective measurements to determine the optimal elbow flexion angle for graft fixation.
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Endoscopic Harvest of Autogenous Gracilis and Semitendinosus Tendons. Arthrosc Tech 2018; 7:e1019-e1024. [PMID: 30377581 PMCID: PMC6203230 DOI: 10.1016/j.eats.2018.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/18/2018] [Indexed: 02/03/2023] Open
Abstract
The hamstring autograft is one of the most popular grafts for anterior cruciate ligament (ACL) reconstruction. Although many techniques for arthroscopic ACL reconstruction using hamstring autografts have been invented, hamstring harvest techniques have not been focused. Hamstrings are harvested using an open technique that requires a 2- to 5-cm skin incision. In this Technical Note, we describe an endoscopic harvest technique of autogenous gracilis and semitendinosus tendon. This technique needs only a 1- to 1.5-cm skin incision and provides surgeons a sufficient view to safely harvest the hamstrings.
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Molenaars RJ, Hilgersom NFJ, Doornberg JN, van den Bekerom MPJ, Eygendaal D. Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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