Elbow ulnar collateral ligament reconstruction: clinical, radiographic, and ultrasound outcomes at a mean 3-year follow-up

Merolla, Giovanni; Sordo, Salvador; Paladini, Paolo; Porcellini, Giuseppe

doi:10.1007/s12306-014-0325-0

Cited by 23 publications

(8 citation statements)

References 30 publications

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“…We observed that mean graft thickness was significantly greater in the 6 pitchers after UCLR compared with unoperated native UCLs as well as significantly decreased ulnohumeral gapping compared with their ND arm and the D arms in uninjured pitchers. This is in contrast to the study by Merolla et al 14 that showed intact grafts with slight medial laxity with the valgus stress maneuver. However, their cohort was very heterogeneous, only included 6 overhead athletes (out of 15) in addition to various injury mechanisms such as elbow dislocations/trauma, different graft selection (autograft/allograft), and different surgical techniques.…”

Section: Discussioncontrasting

confidence: 99%

Professional Pitchers Display Differences in UCL Morphology and Elbow Gapping During Moving Valgus Stress Testing After UCL Reconstruction

Kissenberth

Thigpen

Bailey

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) of the elbow has received much attention given the rise in incidence among baseball pitchers. Stress ultrasonography has been demonstrated to be a critical evaluation tool of the UCL. No study has dynamically evaluated the ability of UCLR to restore normal kinematics. Purpose/Hypothesis: The purpose of this study was to compare ulnohumeral gapping during a moving valgus stress test as well as UCL thickness between professional pitchers with and without UCLR. We hypothesized that the ulnohumeral joint will display greater gapping and the UCL graft will be thicker in pitchers after UCLR compared with uninjured pitchers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Ultrasonography was used to measure the medial ulnohumeral joint distance and the UCL thickness of 70 asymptomatic professional baseball pitchers; 6 of the participants had a history of UCLR. Images were captured of the dominant (D) and nondominant (ND) elbows at the maximal cocking position under 2 loaded conditions within the moving valgus stress test arc: (1) gravity stress and (2) 2.5 kg (5.5 lb) of valgus force using a dynamometer. Intra- and interrater reliability of the measurements was established with intraclass correlation coefficients (ICCs). Separate mixed-model analyses of variance (D side × UCL) were used to compare the D and ND elbow variables between pitchers with and without a history of UCLR. Results: All measurements displayed good reliability according to ICCs. Pitchers with a history of UCLR demonstrated less gapping (5.6 ± 2.9 vs 4.2 ± 1.2 mm; P = .002) and greater UCL graft thickness (0.17 ± 0.07 vs 0.11 ± 0.08 mm; P = .03) compared with the native ligament in pitchers without prior UCL injury. Conclusion: Our data demonstrated that the UCLR results in a thicker, stiffer construct with less medial elbow gapping than the anatomical UCL. Using ultrasound to evaluate the UCL was a reliable, efficient, and clinically feasible method to assess UCL thickness and joint gapping in players with a history of UCLR. Future studies may consider this approach to evaluate surgical techniques and graft types for UCLR.

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Section: Discussioncontrasting

confidence: 99%

Professional Pitchers Display Differences in UCL Morphology and Elbow Gapping During Moving Valgus Stress Testing After UCL Reconstruction

Kissenberth

Thigpen

Bailey

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Surgical outcomes from the literature are listed in Table 2 (see Appendix 1). 6,7,16,18,33,44,49,51,57 Despite the public opinion that pitchers who undergo UCLR throw harder after surgery, evidence has shown that pitchers either maintain the same or lose a very small amount of velocity. 1,30 Unfortunately, no studies to date have shown a benefit to routine ulnar nerve transposition versus transposition in symptomatic patients.…”

Section: Surgical Outcomesmentioning

confidence: 99%

Ulnar Collateral Ligament Reconstruction

et al. 2015

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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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“…Merolla's et al [12] study included 15 patients who underwent UCL reconstruction between 2006-2012. Of the 15 patients, 5 underwent reconstruction with palmaris autograft and 10 underwent reconstruction with semitendinosus allograft.…”

Section: Resultsmentioning

confidence: 99%

Ulnar Collateral Ligament Reconstruction: Allograft Versus Autograft – A Systematic Review

Moore¹,

Matthews²,

Bs³

et al. 2021

OPROJ

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Background: Ulnar Collateral Ligament (UCL) reconstruction of the elbow, a Tommy John surgery, is a common procedure often performed in throwing athletes. Autograft tendon has traditionally been utilized, although recently allograft tendon has been of interest due to the possibility of decreasing donor site morbidity. There is a lack of literature on patient outcomes and complication rates following the use of allograft tendon for UCL reconstruction. Currently, there is no consensus on utilizing autograft versus allograft tendon for UCL reconstruction.Methods: A PRISMA compliant literature search in online databases Medline, Cochrane and Embase was performed for level 4 and higher studies through June 2019. Any studies reporting clinical outcome results of allograft reconstruction were included. Exclusion criteria included studies unrelated to primary UCL reconstruction, studies specifically looking at revision UCL reconstruction, epidemiological studies, case reports, studies lacking raw data, technique articles, biomechanical studies, cadaveric studies, studies with outcomes unrelated to graft choice, and studies with outcomes unrelated to the use of allograft tendon for reconstruction. Studies were analyzed for graft type, functional scores, return to play rate, and complication rates.Results: Three out of 103 studies met inclusion criteria. Two cohort studies and 1 retrospective review were included in this review. No significant differences in functional outcomes regardless of scoring system utilized, return to play rate, or complication rates were found between allograft versus autograft. Conclusion:The use of allograft tendon appears to have similar outcomes regarding functional scores, return to play, and complication rates compared to autograft tendon. Use of allograft tendon seems to be a viable option for UCL reconstruction, though further studies are needed.

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Elbow ulnar collateral ligament reconstruction: clinical, radiographic, and ultrasound outcomes at a mean 3-year follow-up

Abstract: This study confirms the efficacy of the graft reconstruction for chronic UCL insufficiency and introduces fresh insight on the role of musculoskeletal ultrasound to evaluate the reconstructed UCL.

Cited by 23 publications

References 30 publications

Professional Pitchers Display Differences in UCL Morphology and Elbow Gapping During Moving Valgus Stress Testing After UCL Reconstruction

Professional Pitchers Display Differences in UCL Morphology and Elbow Gapping During Moving Valgus Stress Testing After UCL Reconstruction

Ulnar Collateral Ligament Reconstruction

Ulnar Collateral Ligament Reconstruction: Allograft Versus Autograft – A Systematic Review

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