Ulnar Collateral Ligament Reconstruction

Erickson, Brandon J.; Harris, Joshua D.; Chalmers, Peter N.; Bach, Bernard R.; Verma, Nikhil N.; Bush‐Joseph, Charles A.; Romeo, Anthony A.

doi:10.1177/1941738115607208

Cited by 84 publications

(66 citation statements)

References 73 publications

(126 reference statements)

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“…Studies have shown that there is no advantage conferred by the use of a single or double-bundle reconstruction [15]. Classically, the palmaris longus is used, but was nonexistent in this patient [16]. The use of toe extensors has been described for collateral ligaments of the elbow but accounts for less than 2% of all autograft used according to a recent review of the literature and meta-analysis of 619 patients [17–19].…”

Section: Discussionmentioning

confidence: 99%

Complex Case of Open Fracture-Dislocation of the Elbow

Primeau

Beauchamp-Chalifour

Pelet

2019

Case Reports in Orthopedics

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Complex elbow instability is difficult to surgically address. Careful consideration of the fractures and soft tissue injuries is required. We present the case of a patient who sustained an open fracture-dislocation of the elbow with significant loss of the external humeral condyle and partial loss of the olecranon. He was surgically treated with an iliac crest tricortical autograft fixed with a buttress plate and a lag screw. His lateral ulnar collateral ligament was reconstructed with tendinous autograft collected from his third and fourth extensor digitorum longus tendons. While the procedure complicated with a Nocardia infection and wound breakdown, the patient almost had full range of motion without instability at 11 months of follow-up.

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Section: Discussionmentioning

confidence: 99%

Complex Case of Open Fracture-Dislocation of the Elbow

Primeau

Beauchamp-Chalifour

Pelet

2019

Case Reports in Orthopedics

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“…16,18,22,27–29 With the advent of UCL reconstruction, the volume of procedures has increased, as reported in the peer-reviewed literature and public media. 3,9,25,26 However, in 2 reports by Camp et al, 4,5 the incidence of UCL reconstructions may be decreasing among professional baseball players but increasing in younger, minor league players. Hurwit et al 16 surveyed 159 members of the American Shoulder and Elbow Surgeons and found that professional athletes and those with complete tears were indicated for surgery by consensus regardless of the tear location; opinion was more divided on how to treat partial tears or nonprofessionals.…”

mentioning

confidence: 99%

“…Injuries to the medial ulnar collateral ligament (UCL) of the elbow are increasingly diagnosed and treated, particularly among baseball players and other overhead-throwing athletes. 3,7,9,10,15,21 While surgical management has translated to improved functional and patient-reported outcomes, identifying which patients will most likely benefit from UCL reconstruction remains elusive. 16,18,22,27–29 With the advent of UCL reconstruction, the volume of procedures has increased, as reported in the peer-reviewed literature and public media.…”

mentioning

confidence: 99%

Clinical Utility of an MRI-Based Classification System for Operative Versus Nonoperative Management of Ulnar Collateral Ligament Tears: A 2-Year Follow-up Study

Ramkumar

Haeberle

Navarro

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: A recently introduced classification system of medial ulnar collateral ligament (UCL) tears accounting for location and severity has demonstrated high interobserver and intraobserver reliability, but little is known about its clinical utility. Purpose: The primary purpose of this study was to assess the relationship of the magnetic resonance imaging (MRI)–based classification system in predicting which athletes had success with nonoperative versus operative treatment after completing a standardized rehabilitation program. A secondary objective included return to play (RTP) and return to prior performance (RPP) analyses of baseball players. Study Design: Cohort study; Level of evidence, 3. Methods: After an a priori power analysis, 58 consecutive patients with UCL tears and a minimum of 2-year follow-up were retrospectively divided into 2 groups: those who successfully completed operative treatment and those who completed nonoperative treatment. The MRI-based classification stages accounting for UCL tear location and severity were compared between the nonoperative and operative groups. A subanalysis for baseball players, including RTP and RPP, was performed. Results: A total of 58 patients (40 baseball players [34 pitchers]) met inclusion criteria. Of these patients 35 (32 baseball players [27 pitchers]) underwent surgery, and 23 (8 baseball players [7 pitchers]) underwent nonoperative management. No patients in the nonoperative arm crossed over to surgery after completing the rehabilitation program. Patients with distal tears (odds ratio, 48.0; P = .0004) and complete tears (odds ratio, 5.4; P = .004) were more likely to undergo surgery. Baseball players, regardless of position, were confounding determinants of operative management, although there was no difference in RTP and RPP between treatment arms. Conclusion: A 6-stage MRI-based classification system addressing UCL tear location and severity may help early decision making, as patients likely to fail nonoperative treatment have complete, distal tears, whereas those with proximal, partial tears may be more amenable to nonoperative management.

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“…7 Each of these techniques involves drilling either tunnels or a socket in the medial epicondyle. 2,3,9,24…”

mentioning

confidence: 99%

Open Reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers

Erickson

Chalmers

D’Angelo

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure among professional baseball pitchers. An uncommon complication after UCLR is a fracture of the medial epicondyle at the level of the humeral tunnel, which requires open reduction internal fixation (ORIF). Purpose/Hypothesis: The purpose of this study was to determine the performance upon and rate of return to sport (RTS) in professional baseball pitchers after ORIF of the medial epicondyle and examine whether there is a difference in the RTS rate and performance between players who underwent ORIF and matched controls. It was hypothesized that there would be a high rate of RTS in professional baseball pitchers after ORIF of the medial epicondyle, with no difference between the ORIF and control groups in the rate of RTS or performance, specifically related to the primary performance outcome variables of win-loss percentage, walks plus hits per inning pitched, fielding independent pitching, and wins above replacement. Methods: All professional baseball pitchers who underwent ORIF of the medial epicondyle between 2010 and 2016 were included in this study. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between the ORIF and control (no history of UCLR or ORIF) groups. Results: Overall, 15 pitchers (80.0% starters, 73.3% right-handed) underwent ORIF of a medial epicondyle fracture. All had undergone prior UCLR using either the American Sports Medicine Institute (n = 9; 60.0%) or docking (n = 6; 40.0%) technique. ORIF techniques included fixation with 1 screw (n = 13; 86.7%) and fixation with suture anchors (n = 2; 13.3%). Eleven (73.3%) pitchers were able to return to sport (did not differ from controls; P = .537); 55% returned to the same level or higher. No significant differences existed in the primary performance outcome variables when comparing preoperative with postoperative performance. No significant differences in the primary performance outcome variables were seen between the ORIF and control groups after surgery, although players in the ORIF group pitched fewer innings than controls after surgery ( P = .003). Conclusion: After ORIF of the medial epicondyle in professional pitchers with a history of UCLR, 73.3% were able to return to sport (only 55% of those who returned pitched at the same level or higher) without a significant decline in most performance variables when compared with their preoperative performance or matched controls. The number of innings pitched declined after surgery.

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Ulnar Collateral Ligament Reconstruction

Cited by 84 publications

References 73 publications

Complex Case of Open Fracture-Dislocation of the Elbow

Complex Case of Open Fracture-Dislocation of the Elbow

Clinical Utility of an MRI-Based Classification System for Operative Versus Nonoperative Management of Ulnar Collateral Ligament Tears: A 2-Year Follow-up Study

Open Reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers

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