Biomechanical comparison of docking ulnar collateral ligament reconstruction with and without an internal brace

Bernholt, David L.; Lake, Spencer P.; Castile, Ryan M.; Papangelou, Christopher; Hauck, Oliver; Smith, Matthew V.

doi:10.1016/j.jse.2019.04.061

Cited by 25 publications

(53 citation statements)

References 22 publications

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“…These biomechanical studies often involved the use of cadaveric elbows placed in an axial-torsion machine to test the biokinetic properties of the ulnohumeral joint following UCL repair or reconstruction. [12][13][14][20][21][22][23][24][25]27 Of particular interest were the effects of internal bracing on gap formation and load to failure torques. [12][13][14][20][21][22][23][24][25] When Dugas et al first introduced the novel use of IB in the repair of the UCL, they found that at small cyclic torque values, the repair group with the use of IB was more resistant to gap formation compared to a modified Jobe reconstruction.…”

Section: Biomechanicsmentioning

confidence: 99%

“…[12][13][14][20][21][22][23][24][25]27 Of particular interest were the effects of internal bracing on gap formation and load to failure torques. [12][13][14][20][21][22][23][24][25] When Dugas et al first introduced the novel use of IB in the repair of the UCL, they found that at small cyclic torque values, the repair group with the use of IB was more resistant to gap formation compared to a modified Jobe reconstruction. 12 At higher torque values, the repair with IB augmentation offered no statistical differences in gap formation, torsional stiffness, or torque to failure when the two techniques were compared.…”

Section: Biomechanicsmentioning

confidence: 99%

“…12 Biomechanical cadaveric studies have not demonstrated superiority of IB augmentation compared to the traditional techniques without IB utilization. [12][13][14] Despite the discrepancies in the biomechanical studies to date, early clinical studies have shown concrete benefits for UCL repair with IB in athletes. [15][16][17][18] The aim of this review was to evaluate the biomechanical data surrounding the utilization of IB in elbow UCL procedures [repair (no graft utilization) or reconstruction (graft utilization)].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Utilization of Internal Bracing in Elbow Medial UCL Stabilization: From Biomechanics to Clinical Application and Patient Outcomes

Anvari¹,

Fathi²,

Bolia³

et al. 2021

ORR

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Ulnar collateral ligament (UCL) reconstruction has been successfully utilized to treat symptomatic UCL insufficiency in overhead athletes. Despite the overall success of the procedure, attempts have been made to improve upon the original technique with the goal of hastening return to sport. Most recently, there has been interest in repairing or reconstructing the native ligament with internal brace (IB) augmentation. Biomechanical cadaveric studies assessing UCL repair with IB augmentation have attempted to evaluate the efficacy of this treatment; however, the literature is seemingly divided on its benefit. Preliminary clinical studies suggest internal bracing may allow a faster return to sport than conventional techniques. The purpose of this review was to provide an analysis of the current evidence on IB augmentation in UCL repair of the elbow as it pertains to biomechanical advantages/ disadvantages, reported surgical techniques, and clinical outcomes in comparison with traditional UCL reconstruction techniques.

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Section: Biomechanicsmentioning

confidence: 99%

Section: Biomechanicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Utilization of Internal Bracing in Elbow Medial UCL Stabilization: From Biomechanics to Clinical Application and Patient Outcomes

Anvari¹,

Fathi²,

Bolia³

et al. 2021

ORR

View full text Add to dashboard Cite

show abstract

“…Recently, several biomechanical studies have evaluated valgus stability of an internal brace combined with UCRL or repair [34][35][36][37][38]. Most studies demonstrated augmentation with an internal brace providing stability similar to that of the docking technique or more resistance to the valgus load.…”

Section: Biomechanical Studiesmentioning

confidence: 99%

Comparison of Ulnar Collateral Ligament Reconstruction Techniques in the Elbow of Sports Players

Moon

Lee

2020

Clin Shoulder Elbow

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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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“…31 Internal braces have been shown to act as secondary stabilizers of ligaments during reconstructive procedures of the anterior cruciate ligament, medial collateral ligament, and ulnar collateral ligament. 2,7 Support is growing for their use as a novel technique in foot and ankle, sports, and hand procedures, with some studies reporting a quicker return to activity and better outcomes in athletes. 1,4,11,19 These data contribute to the growing body of literature suggesting that current surgical repair constructs for syndesmotic injuries, although effective, may not functionally restore the native biomechanical environment.…”

Section: Clinical Impact: Redefining Ideal Constructsmentioning

confidence: 99%

Normal Kinematics of the Syndesmosis and Ankle Mortise During Dynamic Movements

Hogg-Cornejo

Hunt

Bartolomei

et al. 2020

Foot & Ankle Orthopaedics

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Background: Documenting the healthy articulation of the syndesmosis and talocrural joints, and measurement of 3D medial and lateral clear spaces may improve diagnostic and treatment guidelines for patients suffering from severe syndesmotic injury or chronic instability. This study aimed to define the range of motion (ROM) and displacement of the fibula and talus during static and dynamic activities, and measure the 3D movement in the tibiofibular (syndesmosis) and medial clear space. Methods: Six healthy volunteers performed dynamic weightbearing motions on a single-leg: heel-rise, squat, torso twist, and box jump. Participants posed in a nonweightbearing neutral stance as well as weightbearing neutral standing, plantarflexion, and dorsiflexion. High-speed stereoradiography measured 3D rotation and translation of the fibula and talus throughout each task. Medial clear space and tibiofibular gap distances were measured under each condition. Results: Total ROM for the fibula was greatest in internal-external rotation (9.3 ± 3.5 degrees), and anteroposterior (3.3 ± 2.2 mm) and superior-inferior (2.5 ± 0.9 mm) translation, rather than lateral widening (1.7 ± 1.0 mm). The total rotational ROM of the talus was greatest in dorsiflexion-plantarflexion (34.7 ± 12.9 degrees) and internal-external rotation (15.0 ± 3.4 degrees). Single-leg squatting increased the lateral clear space ( P = .045) and widened the medial tibiofibular joint, whereas single-leg heel-rises decreased the lateral clear space ( P = .001) and widened the tibiotalar space. Gap spaces in the tibiofibular and medial clear spaces did not exceed 2.3 ± 0.9 mm and 2.7 ± 1.2 mm, respectively. Conclusion: These data support a potential shift in the clinical understanding of fibula displacements during dynamic activities and how implant device constructs might be developed to restore physiologic mechanics. Clinical Relevance: Syndesmosis stabilization and rehabilitation should consider restoration of normal physiologic rotation and translation of the fibula and ankle mortise rather than focusing solely on the restriction of lateral translation.

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Biomechanical comparison of docking ulnar collateral ligament reconstruction with and without an internal brace

Cited by 25 publications

References 22 publications

Utilization of Internal Bracing in Elbow Medial UCL Stabilization: From Biomechanics to Clinical Application and Patient Outcomes

Utilization of Internal Bracing in Elbow Medial UCL Stabilization: From Biomechanics to Clinical Application and Patient Outcomes

Comparison of Ulnar Collateral Ligament Reconstruction Techniques in the Elbow of Sports Players

Normal Kinematics of the Syndesmosis and Ankle Mortise During Dynamic Movements

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