Medial Ulnar Collateral Ligament Repair With Internal Brace Augmentation: Results in 40 Consecutive Patients

Abstract

Background: Medial ulnar collateral ligament (MUCL) repair has been proven to be effective in nonprofessional overhead-throwing athletes, with faster and higher rates of return to play (RTP) than the more traditional Tommy John reconstruction. Biomechanical studies and clinical data suggest that MUCL repair augmented with a collagen-coated internal brace may be an effective treatment option in this patient population. Purpose: To evaluate the functional outcomes of young nonprofessional athletes who underwent MUCL repair with internal brace augmentation for medial elbow instability. The hypothesis was that these patients will have high rates of RTP and improved functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: Nonprofessional overhead athletes treated with MUCL repair with internal brace augmentation between 2015 and 2017 were prospectively evaluated for a minimum of 1 year. Preoperatively, all patients had evidence of medial elbow pain caused by MUCL insufficiency, as confirmed by signal changes on magnetic resonance imaging and valgus instability on arthroscopic examination. These findings did not allow them to participate in their chosen sport or profession, and each patient had failed nonoperative treatment. Postoperative outcomes were evaluated using the Overhead Athlete Shoulder and Elbow Score of the Kerlan-Jobe Orthopaedic Clinic. Complications were recorded and detailed. Results: A total of 40 nonprofessional overhead athletes were included in this study (35 men and 5 women; mean age, 17.8 years [range, 14-28 years]). The mean follow-up time was 23.8 months (range, 12-44 months). The mean postoperative Kerlan-Jobe Orthopaedic Clinic score was 92.6 (range, 64-100). Overall, 37 athletes (92.5%) returned to play or profession at the same level or higher at a mean time of 6.9 months (range, 2-12 months). Three patients did not RTP: 1 was limited by a concomitant medical diagnosis, and the other 2 chose not to resume athletics after the procedure but remained symptom free. Conclusion: In the nonprofessional athlete, primary MUCL repair with internal brace augmentation is a viable alternative to traditional repair techniques or reconstruction, allowing for a rapid RTP and promising functional outcomes.

Systematic Assessment of the Quality and Comprehensibility of YouTube Content on Ulnar Collateral Ligament Injury and Management

“…Interestingly, only 3 videos discussed indications for UCL repair (as opposed to UCL reconstruction) despite an abundance of recent research demonstrating considerable success with UCL repair when performed for the proper indications. 15 , 35 , 47 , 48 This finding could be representative of the lag between the publication of novel research in peer-reviewed journals and the incorporation of these findings into freely available online video content. As orthopaedic surgery continues to evolve as a field, there will be a continued need to produce updated online patient education materials so that patients can fully consider all available options.…”

Intersurgeon Consistency of Ulnar Collateral Ligament Repair With Internal Brace: A Biomechanical Analysis

“…Dugas et al 7 described a technique of repairing a torn UCL with suture tape (now called internal brace) augmentation. There have been other techniques described, 13 , 14 , 19 – 22 all with the same indications of acute UCL injury with good ligamentous quality. In a study by Rothermich et al 18 of Division 1 National Collegiate Athletic Association baseball players who underwent UCL surgery, the proportion of patients who underwent UCL repair increased each year, from 10% in 2017, to 20% in 2018, and 25% in 2019.…”

“…Dugas et al 7 reported 5 complications from their cohort of 111 patients, with 3 related to either ulnar neuritis or instability, 1 due to heterotopic ossification, and 1 due to painful retained suture. A cohort of 40 nonprofessional overhead athletes with mean follow-up of 23.8 months were found to have a 92.5% return to play and mean Kerlan-Jobe Orthopaedic Clinic score of 92.6 after undergoing UCL repair by O’Connell et al 13 …”

“…Dugas et al 7 reported 5 complications from their cohort of 111 patients, with 3 related to either ulnar neuritis or instability, 1 due to heterotopic ossification, and 1 due to painful retained suture. A cohort of 40 nonprofessional overhead athletes with mean followup of 23.8 months were found to have a 92.5% return to play and mean Kerlan-Jobe Orthopaedic Clinic score of 92.6 after undergoing UCL repair by O'Connell et al 13 Patients undergoing UCL repair have much shorter rehabilitation times, with most throwing athletes returning to competition by as early as 5 months postsurgery. 23 A 2021 study by Rothermich et al 17 reviewed 353 patients who underwent a UCL repair with the above-mentioned technique and found that 11.9% reported minor complications and only 3.4% required a return to the operating room for ulnar nerve debridement/exploration, primary ulnar nerve transposition, or heterotopic ossification excision.…”

Medial Ulnar Collateral Ligament Repair With Augmentation: A Systematic Review and Meta-analysis of Preclinical Studies

“…The anterior bundle of the medial ulnar collateral ligament (MUCL) complex is the primary restraint to valgus stress at the elbow during overhead throwing. 32 , 36 Injury classically affects baseball pitchers, because of the high and repetitive stress on the ligament. 20 Primary repair was historically the treatment of choice.…”