The GraftLink Ulnar Collateral Ligament Reconstruction

Lynch, Jamie L.; Pifer, Matthew; Maerz, Tristan; Kurdziel, Michael D.; Davidson, Abigail A.; Baker, Kevin C.; Anderson, Kyle

doi:10.1177/0363546513498999

Cited by 28 publications

(10 citation statements)

References 32 publications

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“…Paletta et al 28 reported in a cadaveric study that the docking technique may offer an initial biomechanical advantage over the Jobe construct; however, on the whole, biomechanical studies have failed to consistently demonstrate the superiority of any particular surgical technique. 3,10,16,22,23,26 The current study did not show any statistically significant differences in subsequent injuries or subsequent surgeries between surgical techniques or graft constructs. The high rate found in the current study of subsequent elbow injury (29.8%) following revision UCL is consistent with other studies examining subsequent injury rates in professional baseball players undergoing primary UCL reconstruction.…”

Section: Discussioncontrasting

confidence: 50%

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Camp

Desai

Conte³

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Ulnar collateral ligament (UCL) reconstruction of the elbow is commonly performed on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought. Purpose: To provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Study Design: Case series; Level of evidence, 4. Methods: The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS, and surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play [RTP] rates, RTP times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (docking vs modified Jobe) and graft sources (palmaris longus autograft vs hamstring autograft). Results: A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1424 days (47 months) after their primary surgery. A trend was seen toward increasing numbers of revision surgeries over time ( R2 = 0.441; P = .104). The most commonly used tunnel configuration was the modified Jobe technique (n = 41; 59.4%), and the most commonly used graft was hamstring autograft (n = 34; 49.3%). A majority (76.6%) of pitchers achieved RTP, and 55.3% were able to return to the same level of play. Mean time to RTP was 436 days (14.5 months) for players with a palmaris longus autograft versus 540 days (18 months) for those with a hamstring autograft ( P = .108). Further, the mean time to RTP was 423 days (14 months) for the docking technique versus 519 days (17 months) for the modified Jobe technique ( P = .296). Similar rates of subsequent injuries and surgeries were noted between the 2 revision techniques and 2 most commonly used graft constructs. Conclusion: Revision UCL reconstruction showed relatively high RTP rates (77%), but only 55% of players returned to their same level of play. Mean time to RTP was shorter than that found in other, smaller investigations. Although general trends were seen toward decreased time to RTP for the docking technique and palmaris longus autograft, these differences did not reach statistical significance.

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Section: Discussioncontrasting

confidence: 50%

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Camp

Desai

Conte³

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…The primary findings of this study were that the mean load to failure for elbows in the docking technique group was 23.8 ± 6.1 versus 31.9 ± 8.4 N·m in the anatomic technique group. This ultimate load to failure of 32 N·m is greater than that of other described UCL reconstruction/repair techniques 12,20,36,42,45 and similar to that of the native ligament. 1,28 While the most common mechanism of failure was suture pullout from the graft, this occurred on the ulnar side of the anatomic technique, as opposed to the humeral side in the docking technique.…”

Section: Discussionmentioning

confidence: 66%

“…In biomechanical studies where the docking technique was performed on cadaveric elbows and then subjected to biomechanical testing, the load to failure averaged 4.85 to 18.86 N·m. 12,36,42,45 In studies where biomechanical testing was performed on cadaveric elbows after the modified Jobe technique, the load to failure was found to average 8.9 to 20.9 N·m. 20,42 Dugas et al 20 investigated the load to failure of UCL repair with internal bracing and found it to be a mean of 23.6 N·m.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to previous investigations, samples were oriented at 90° of elbow flexion with the humerus oriented vertically and secured inline with the system actuator (Figure 3). 11,12,36,45 A valgus rotational torque was applied to the humerus at a constant rate of 5 deg/s while the forearm was held stationary. The elbow was loaded at this constant rate until ultimate mechanical failure of the construct occurred.…”

Section: Methodsmentioning

confidence: 99%

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Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow: Biomechanical Comparison of a Novel Anatomic Technique to the Docking Technique

Camp

Bernard

Benavitz

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:In recent years, understanding of the anatomy of the ulnar collateral ligament (UCL) has evolved, demonstrating that the insertional footprint of the UCL on the ulna is more elongated and distally tapered than previously described. Current UCL reconstruction configurations do not typically re-create this native anatomy, which may represent a potential area for improvement.Purpose/Hypothesis:The purposes of this study were (1) to describe a novel anatomic UCL reconstruction technique designed to better replicate the native UCL anatomy and (2) to biomechanically compare this with the docking technique. The hypothesis was that the ultimate load to failure for the anatomic technique would not be inferior to the docking technique.Study Design:Controlled laboratory study.Methods:A total of 16 fresh-frozen cadaveric upper extremities (8 matched pairs) were utilized. One elbow in each pair was randomized to receive UCL reconstruction via the docking technique or the novel anatomic UCL reconstruction technique with palmaris tendon autograft. Following reconstruction, biomechanical testing was performed by applying valgus rotational torque at a constant rate of 5 deg/s until ultimate mechanical failure of the construct occurred. Maximal torque (N·m), rotation stiffness (N·m/deg), and mode/location of failure were recorded for each specimen.Results:The mean ultimate load to failure for elbows in the docking technique group was 23.8 ± 6.1 N·m, as compared with 31.9 ± 8.4 N·m in the anatomic technique group (P = .045). Mean rotational stiffness was 1.9 ± 0.7 versus 2.3 ± 0.9 N·m/deg for the docking and anatomic groups, respectively (P = .338). The most common mode of failure was suture pullout from the graft, which occurred in all 8 (100%) docking technique specimens and 7 of 8 (88%) specimens that underwent the anatomic UCL reconstruction technique.Conclusion:Ultimately, the anatomic UCL reconstruction technique demonstrated superior strength and resistance to valgus torque when compared with the docking technique, and this was comparable with that of the native UCL from prior studies. Increased initial strength may allow for earlier initiation of throwing postoperatively and potentially shorten return-to-play times.Clinical Relevance:Current UCL reconstruction techniques do not accurately reproduce the UCL insertional anatomy on the ulna. The novel anatomic technique described may result in more natural joint kinematics. This study demonstrated load-to-failure rates that are significantly higher than with the docking technique and consistent with the native ligament, as reported from previous studies. These findings may serve as a foundation for future clinical study and optimization of this technique.

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“…On the whole, no technique or graft choice appears to be consistently biomechanically superior. 29 , 39 , 40 , 45 A recent systematic review of 21 biomechanical and clinical studies including 1368 patients concluded that the docking technique resulted in a higher rate of return to play and lower complication rate compared with both the Jobe and modified Jobe techniques. 66 Comparative clinical studies regarding graft choice are not available.…”

Section: Surgical Outcomesmentioning

confidence: 99%

Ulnar Collateral Ligament Reconstruction

Erickson

Harris

Chalmers

et al. 2015

Sports Health: A Multidisciplinary Approach

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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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The GraftLink Ulnar Collateral Ligament Reconstruction

Cited by 28 publications

References 32 publications

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow: Biomechanical Comparison of a Novel Anatomic Technique to the Docking Technique

Ulnar Collateral Ligament Reconstruction

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