Repair of the ulnar collateral ligament of the elbow with internal brace augmentation: a 5-year follow-up

Wilson, William T.; Hopper, Graeme P.; Byrne, Paul; Mackay, Gordon

doi:10.1136/bcr-2018-227113

Cited by 16 publications

(6 citation statements)

References 35 publications

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“…An additional case study cited the RTP of a college football player 4 months postoperation. 35 We found high RTP rates (92.5%) at a mean 6.9 months, which is similar to results recently published by Dugas et al 10,34 Comparatively, in a large study on reconstructions, Cain et al 6 stated that 83% of patients returned to play at a mean 11.6 months.…”

Section: Discussionsupporting

confidence: 91%

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

O’Connell

Hoof

Heffernan

et al. 2021

Orthopaedic Journal of Sports Medicine

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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.

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Section: Discussionsupporting

confidence: 91%

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

O’Connell

Hoof

Heffernan

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…As this is a relatively new procedure, current outcomes in the literature are limited but have demonstrated the ability to undergo early rehabilitation, accelerated return to play compared with UCL reconstruction, and favorable rates of return to play. 12 , 33 In our experience, revision procedures have not posed a major challenge. This may be because we use a polyetheretherketone polymer anchor to minimize cyst formation, tunnel expansion, or osteolysis, while permitting anchor removal in a revision setting.…”

Section: Discussionmentioning

confidence: 86%

The Effect of Ulnar Collateral Ligament Repair With Internal Brace Augmentation on Articular Contact Mechanics: A Cadaveric Study

Roth

Beason

Clay

et al. 2021

Orthopaedic Journal of Sports Medicine

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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 contact mechanics and overall joint torque and stiffness were recorded. Results: Contact mechanics of reconstructed and repaired specimens were not significantly different. Both reconstruction and repair procedures returned the overall resistance of the joint to valgus torsion to near-intact levels. UCL repair tended to restore joint torque more closely to the intact state than did reconstruction, given that reconstruction showed a nonsignificant trend toward lower torque than the intact state ( P = .07). Conclusion: Neither UCL reconstruction nor UCL repair with InternalBrace overconstrained the elbow joint, as both groups had similar contact pressures compared with the native joint. Both procedures also restored elbow joint torque and stiffness to levels not statistically different from the intact state. Clinical Relevance: Given the sound biomechanical properties of UCL repair with InternalBrace, it may have a significant role as treatment for UCL injuries.

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“…Jones et al 152 reported similar results when comparing specimen repaired with internal brace with specimen reconstructed with the modified Jobe technique. Recently, Wilson et al 153 reported one case of a collegiate football athlete who suffered a complete tear of the UCL and was treated with primary UCL repair with internal brace and achieved excellent recovery with RTS at 3 months. This case also demonstrated excellent elbow function and RTP at the same level 5 years later.…”

Section: Medial Elbow Pathologymentioning

confidence: 99%

“…This case also demonstrated excellent elbow function and RTP at the same level 5 years later. 153 While the evidence regarding clinical outcomes is sparse, repair techniques with internal brace are promising and continue to gain popularity. 154 Study outcomes of reconstruction and repair techniques for UCL rupture are summarized in Tables 7 – 9 .…”

Section: Medial Elbow Pathologymentioning

confidence: 99%

Evaluation and management of elbow injuries in the adolescent overhead athlete

2021

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With an increased interest in youth sports, the burden of overhead throwing elbow injuries accompanying early single-sport focus has steadily risen. During the overhead throwing motion, valgus torque can reach and surpass Newton meters (N m) during the late cocking and early acceleration phases, which exceeds the tensile strength (22.7–33 N m) of the ulnar collateral ligament. While the ulnar collateral ligament serves as the primary valgus stabilizer between and degrees of elbow flexion, other structures about the elbow must contribute to stability during throwing. Depending on an athlete’s stage of skeletal maturity, certain patterns of injury are observed with mechanical failures resulting from increased medial laxity, lateral-sided compression, and posterior extension shearing forces. Together, these injury patterns represent a wide range of conditions that arise from valgus extension overload. The purpose of this article is to review common pathologies observed in the adolescent overhead throwing athlete in the context of functional anatomy, osseous development, and throwing mechanics. Operative and non-operative management and their associated outcomes will be discussed for these injuries.

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Repair of the ulnar collateral ligament of the elbow with internal brace augmentation: a 5-year follow-up

Cited by 16 publications

References 35 publications

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

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

The Effect of Ulnar Collateral Ligament Repair With Internal Brace Augmentation on Articular Contact Mechanics: A Cadaveric Study

Evaluation and management of elbow injuries in the adolescent overhead athlete

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