Ulnar Collateral Ligament Reconstruction Versus Repair With Internal Bracing: Comparison of Cyclic Fatigue Mechanics (original) (raw)
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Orthopaedic Journal of Sports Medicine
Objectives: UCL reconstruction has become the preferred treatment for UCL injury in elite throwers desiring a return to throwing. Prior reports of UCL repair demonstrated poor results in professional pitchers, with rate of return to the same or higher level pitching between 0% and 63%. 1,3,6,9,11 However, in young athletes without chronic attritional UCL damage, recent data shows reliable and rapid return to sport with primary UCL repair.2,12,14 We previously introduced a novel UCL repair technique consisting of primary UCL repair, augmented with a spanning tape anchored at either end of the native ligament. Compared to UCL reconstruction, this construct demonstrated significantly greater resistance to gap formation, even at low cycles of valgus loading.8 The purpose of the current study was to compare the high-cycle fatigue mechanics of augmented UCL repair versus modified Jobe UCL reconstruction. We hypothesized that the repaired specimens would have less gap formation compared to...
The American Journal of Sports Medicine, 2020
Background: Biomechanical studies have compared augmented primary repair with internal bracing versus reconstruction techniques of the anterior ulnar collateral ligament (aUCL) in the elbow. However, aUCL repair alone has not been compared with augmented repair or reconstruction techniques. Hypothesis: Internal bracing of aUCL repair provides improved time-zero stabilization in terms of gap formation, torsional stiffness, and residual torque compared with both repair alone and the modified docking technique, with enhanced valgus stability restoration to that of the native ligament. Study Design: Controlled laboratory study. Methods: We randomized 8 matched pairs of cadaveric elbows to undergo either augmented aUCL repair or a modified docking technique through use of the palmaris longus tendon. Valgus laxity testing was consecutively performed at 90° of flexion on the intact, torn, and repaired conditions as well as the previously assigned techniques. First, intact elbows were loade...
Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction Techniques
The American Journal of Sports Medicine, 2008
Background Incompetence of the ulnar collateral ligament (UCL) of the elbow is career-threatening for high-performance throwing athletes. Although multiple reconstructions have been described, a procedure that combines a larger graft with improved fixation may demonstrate more favorable loading characteristics than current techniques. Hypothesis Ulnar collateral ligament reconstructions utilizing a semitendinosus graft and interference knot fixation will be biomechanically superior to previously reported techniques. Study Design Controlled laboratory study. Methods Thirty cadaveric elbows were stripped of all medial soft tissue superficial to the UCL. The proximal humeri were mounted on a materials testing system with the elbows flexed 90°. The intact UCL was loaded to failure at 4.5 deg/s. The torsional failure moment, torsional stiffness, and mode of failure were recorded. Three groups of 10 specimens were created. Group 1 underwent reconstruction using a palmaris tendon graft sec...
Orthopaedic Journal of Sports Medicine
Background: There has been renewed interest in ulnar collateral ligament (UCL) repair in throwing athletes because of a greater understanding of UCL injuries, improvement in ligament repair technology, and potentially expedited rehabilitation time and return to play relative to UCL reconstruction. Purpose: To evaluate elbow articular contact and overall joint torque after UCL reconstruction and repair augmented with a collagen-coated fiber tape, InternalBrace. Study Design: Controlled laboratory study. Methods: Ten matched pairs of cadaveric arms (mean age, 41 ± 11 years) were dissected to expose the UCL. Each specimen was secured into a custom test fixture at 90°, and 1 specimen from each pair underwent either a modified Jobe UCL reconstruction or UCL repair with InternalBrace. Each specimen underwent 10 cycles of elbow valgus angular displacement between 0° and 5° at a rate of 1 deg/s in the intact state, after UCL avulsion, and then after UCL reconstruction or repair. Articular c...
Arthroscopy, Sports Medicine, and Rehabilitation, 2020
The purpose of this study is to investigate the trends concerning ulnar collateral ligament (UCL) reconstruction (UCLR) for athletic injuries within the United States over the years 2003 to 2014. Methods: A retrospective review of the Truven Health MarketscanÒ Commercial Database was conducted for patients undergoing UCLR. Data was reviewed for patients treated between 2003 and 2014, and the cohort of patients undergoing UCLR was queried using Common Procedural Terminology code 24346. Patients ages 11 to 40 years were included and divided into 6 different age groups, with the rate of UCLR calculated for each group. Results: The overall rate of UCLR increased from 4.4 per million in 2003 to 11.9 per million in 2014 (p < .01). Throughout the same time period, the rate per million increased from 3.3 to 22.1 in 11-to 15-year-olds (p < .01), from 105.4 to 293.2 in 16-to 20-year-olds (p < .01), from 23.1 to 67.0 in 21-to 25-year-olds (p < .01), and from 2.1 to 5.7 in 31-to 35-year-olds (p < .01). There was no significant increase in the rate of UCLR in the age groups of 26 to 30 and 36 to 40 years. Conclusion: UCLR was mostly performed in patients aged 11 to 25 years (96.6%), and specifically most common in those patients aged 16 to 20 years (67.4%). The rate of UCLR procedures increased over time for younger age groups significantly more than for their older counterparts. Clinical Relevance: UCLR rates are increasing in young patients despite efforts addressing injury risk reduction strategies and education for coaches, players, and parents regarding risk factors for UCL injury.
Current Concepts in Rehabilitation Following Ulnar Collateral Ligament Reconstruction
Sports Health: A Multidisciplinary Approach, 2009
Injuries to the ulnar collateral ligament (UCL) in throwing athletes frequently occurs from the repetitive valgus loading of the elbow during the throwing motion, which often results in surgical reconstruction of the UCL requiring a structured postoperative rehabilitation program. Several methods are currently used and recommended for UCL reconstruction using autogenous grafts in an attempt to reproduce the stabilizing function of the native UCL. Rehabilitation following surgical reconstruction of the UCL begins with range of motion and initial protection of the surgical reconstruction, along with resistive exercise for the entire upper extremity kinetic chain. Progressions for resistive exercise are followed that attempt to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers, in addition to the distal upper extremity musculature, to allow for a return to throwing and overhead functional activities. Rehabilitation following UCL reconstruction has produced favorable outcomes, allowing for a return to throwing in competitive environments.
Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes
Sports health, 2015
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. 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. Clinical review. Level 5. 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 spor...
Ulnar Collateral Ligament Repair
Orthopedic Clinics of North America, 2019
Ulnar collateral ligament (UCL) injuries are increasing in adolescent overhead athletes. There is a wide spectrum of UCL injuries ranging from partial tears and end avulsions to chronic attritional tears. UCL reconstruction has been the gold standard for treating all varieties of UCL injuries since Dr Frank Jobe performed the first UCL reconstruction in 1974 on Tommy John. Newer techniques of UCL reconstruction for partial tears or end avulsions have shown promising results with accelerated rehabilitation and earlier return to play compared with conventional UCL reconstruction.