Mechanical properties and microstructural organization of common ulnar collateral ligament grafts: Palmaris longus and gracilis tendons

Background: Professional baseball pitchers are at high risk for tears of the ulnar collateral ligament (UCL) of the elbow, often requiring surgical reconstruction. Despite acceptable published return-to-play outcomes, multiple techniques and graft types have been described. Purpose: This study compares UCL reconstruction (UCLR) outcomes based on tunnel configuration and graft type. Study Design: Cohort study; Level of evidence, 3. Methods: After approval from our institutional review board and Major League Baseball (MLB), 566 professional baseball pitchers who underwent UCLR between 2010 and 2014 were identified and included. The following patient characteristics were analyzed: age, pitching role (starter vs reliever), level of play (MLB vs Minor League Baseball [MiLB]), and throwing side dominance. Surgical factors analyzed included reconstruction technique, graft type, and concomitant procedures. Primary outcome measures consisted of the ability to return to play at any level (RTP), ability to return to the same level of play (RSL), time to return, subsequent elbow injuries, and need for subsequent or revision elbow surgery. The effects of patient and surgical factors on outcomes were analyzed using multivariate linear and logistic regression modeling. Results: The RTP rate was 79.9%, and the RSL rate was 71.2%. Grafts used to reconstruct the UCL included the palmaris longus autograft (n = 361, 63.7%), the gracilis autograft (n = 135, 23.8%), and other grafts (n = 70, 12.5%). Surgical techniques utilized were the docking technique (n = 171, 30.2%), the modified Jobe technique (n = 290, 51.2%), and other techniques (n = 105, 18.6%). There were no significant differences in the time to RTP or RSL based on reconstruction technique or graft type. RTP rates were similar for the docking versus modified Jobe technique (80.1% vs 82.4%, respectively; P = .537) and for the 2 primary graft types (83.1% for palmaris longus vs 80.7% for gracilis; P = .596). The rate of subsequent elbow surgery was 10.5% for the docking technique versus 14.8% for the modified Jobe technique ( P = .203), and the rate of revision UCLR was 2.9% versus 6.2% for the docking versus modified Jobe technique, respectively ( P = .128). Significant trends toward an increasing use of the palmaris longus autograft ( P = .023) and the docking technique ( P = .006) were observed. MLB pitchers were more likely than MiLB pitchers to RTP ( P < .001) and RSL ( P < .001), but they required a longer time to return (mean difference, 35 days; P = .039) and had a higher likelihood of subsequent elbow (odds ratio [OR], 3.58 [95% CI, 2.06-6.23]; P < .001) and forearm injuries (OR, 5.70 [95% CI, 1.99-16.30]; P = .004) but not subsequent elbow surgery. No specific variables correlated with the rates of subsequent elbow surgery or revision UCLR in the multivariate analysis. The use of concomitant ulnar nerve transposition did not affect outcomes. Conclusion: Surgical outcomes in professional baseball players are not significantly influenced by UCLR technique or graft type. There was a high rate (46.3%) of subsequent throwing elbow injuries. MLB pitchers were more likely to RTP and RSL, but they had a higher frequency of subsequent elbow and forearm injuries than MiLB pitchers. Both the docking technique and the palmaris longus autograft are increasing in popularity among surgeons treating professional baseball players.

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Evaluating Changes in Shear Modulus of Elbow Ulnar Collateral Ligament in Overhead Throwing Athletes Over the Course of a Competitive Season

Journal of Engineering and Science in Medical Diagnostics and Therapy ◽

10.1115/1.4041503 ◽

2018 ◽

Vol 1 (4) ◽

Cited By ~ 1

Author(s):

Seyedali Sadeghi ◽

Che-Yu Lin ◽

Dov A. Bader ◽

Daniel H. Cortes

Keyword(s):

Mechanical Properties ◽

Shear Modulus ◽

Ulnar Collateral Ligament ◽

College Level ◽

Clinical Tool ◽

Collateral Ligament ◽

Time Points ◽

Competitive Season ◽

Repetitive Loading ◽

Overhead Throwing

The anterior band of the ulnar collateral ligament (UCL) is commonly subjected to repetitive stress in overhead-throwing athletes, causing high subfailure strain and change in mechanical properties of the ligament. Understanding the change in UCL mechanical properties after repetitive loading can help to evaluate the health status of UCL. The objective of this study was to evaluate changes in UCL shear modulus in overhead-throwing, Division I college-level athletes over the course of a competitive season using ultrasound shear wave elastography (SWE). The proposed protocol quantified changes in shear modulus of UCL in 17 baseball players at preseason and season-end time points as well as in five football quarterbacks at preseason, midseason, and season-end time points. The highest shear modulus values were obtained in the nondominant arm at preseason time points in both groups of athletes. The average UCL shear modulus at the season-end decreased by 39.35% and 37.96% compared to the preseason values in dominant and nondominant arms, respectively. This study shows that SWE could quantify changes in the shear modulus of the UCL after repetitive loading, suggesting that it could be a useful clinical tool for evaluating the risk of UCL injury. Further research on injured overhead-throwing athletes is warranted.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119864104 ◽

2019 ◽

Vol 7 (8) ◽

pp. 232596711986410 ◽

Cited By ~ 2

Author(s):

Christopher L. Camp ◽

Vishal Desai ◽

Stan Conte ◽

Christopher S. Ahmad ◽

Michael Ciccotti ◽

...

Keyword(s):

Surgical Techniques ◽

Ulnar Collateral Ligament ◽

Return To Play ◽

Professional Baseball ◽

Hamstring Autograft ◽

Collateral Ligament ◽

Current Trends ◽

Palmaris Longus ◽

Baseball Pitchers ◽

Mean Time

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00362 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0036

Author(s):

Christopher L. Camp ◽

Vishal Shwetal Desai ◽

Stan Conte ◽

Christopher S. Ahmad ◽

Michael G. Ciccotti ◽

...

Keyword(s):

Surgical Techniques ◽

Ulnar Collateral Ligament ◽

Return To Play ◽

Professional Baseball ◽

Hamstring Autograft ◽

Collateral Ligament ◽

Current Trends ◽

Palmaris Longus ◽

Baseball Pitchers ◽

Mean Time

Objectives: Ulnar collateral ligament (UCL) reconstruction of the elbow is a commonly performed surgery on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought. The purpose of this study is 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. Methods: The Major League Baseball (MLB) 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 while surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play rates, return to play 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 1,424 days (47 months) after their primary surgery. There was a trend toward increasing numbers of revision surgeries over time (R2=0.441; p=0.104). The most commonly used tunnel configuration was the Modified Jobe technique (n=41, 59.4%) and the most common graft utilized was hamstring autograft (n=34, 49.3%). 76.6% of pitchers were able to return to play (RTP) and 55.3% were able to return to the same level of play. Mean time to RTP in players with a palmaris longus autograft was 436 days versus 540 days for hamstring autograft (p=0.108) and the mean time to RTP in players was 423 days for the Docking technique versus 519 days for the Modified Jobe technique (p=0.296). Similar rates of subsequent injuries and surgeries were noted between the two revision techniques and two most commonly used graft constructs. Conclusion: This report detailing revision UCL reconstruction amongst professional baseball pitchers showed a trend towards increasing numbers of revisions being performed, a finding consistent with other recent studies. The overall return to play percentage was higher than previously reported (76.6%); however, significantly fewer (55.3%) players returned to the same level of play. This work also demonstrated decreased return to play times (n=484 days, SD: 117.3) compared to other investigations. The Modified Jobe was the most commonly used surgical technique and the two most commonly used graft constructs were hamstring autograft and palmaris longus autograft. Although this analysis did not reveal any statistically significant comparative differences between surgical techniques or graft constructs, future studies involving head-to-head comparisons of these surgical variables, specific to revision UCL reconstruction, may be helpful in improving player outcomes and career performance.

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Return-to-Sport Outcomes After Primary Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Tendon Grafts: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211055726 ◽

2021 ◽

Vol 9 (12) ◽

pp. 232596712110557

Author(s):

David P. Trofa ◽

Michael Constant ◽

Connor R. Crutchfield ◽

Nicholas J. Dantzker ◽

Bryan M. Saltzman ◽

...

Keyword(s):

Systematic Review ◽

Return To Sport ◽

Ulnar Collateral Ligament ◽

Hamstring Tendon ◽

Cochrane Library ◽

Hamstring Graft ◽

Collateral Ligament ◽

Palmaris Longus ◽

The Mean ◽

Tendon Grafts

Background: Ulnar collateral ligament (UCL) reconstruction is the current gold standard of treatment for overhead athletes with a symptomatic, deficient UCL of the elbow who have failed nonoperative treatment and wish to return to sport (RTS) at a high level. The palmaris longus and hamstring tendons are common graft choices, but no study has analyzed the existing literature to assess whether one graft is superior to the other. Purpose: To systematically report on the outcomes of UCL reconstruction using palmaris and hamstring autografts. Study Design: Systematic review; Level of evidence, 4. Methods: A combination of the terms “ulnar collateral ligament,” “valgus instability,” “Tommy John surgery,” “hamstring,” and “palmaris longus” were searched in PubMed, Embase, and the Cochrane Library. RTS and return-to-same-level (RSL) rates, patient-reported outcomes, and complications were included for analysis. We used the modified Coleman Methodology Score and risk-of-bias tool for nonrandomized studies to assess the quality of the included studies. Results: This review included 6 studies (combined total of 2154 elbows) that directly compared palmaris and hamstring graft use in UCL reconstruction. Follow-up ranged from 24 to 80.4 months, and the mean patient age across all studies was 21.8 years. The mean RSL across all studies and grafts was 79.0%, and the mean RTS was 84.1%, consistent with results previously reported in the literature. The mean RTS and RSL rates for the palmaris graft group were 84.6% and 82%, respectively; the hamstring graft group showed mean RTS and RSL rates of 80.8% and 80.8%. Meta-analysis revealed no significant difference in RSL between the 2 graft groups (odds ratio, 1.06; 95% CI, 0.77-1.46). The combined complication rate of the included studies was 18.2%, with failure rates ranging from 0% to 7.1%. Conclusion: Results of this review indicated that both palmaris and hamstring tendon grafts are viable options for primary UCL reconstruction. Graft choice should be determined by a combination of patient and surgeon preference.

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Ultrasound Shear Wave Elastography of the Elbow Ulnar Collateral Ligament: Reliability Test and a Preliminary Case Study in a Baseball Pitcher

Journal of Engineering and Science in Medical Diagnostics and Therapy ◽

10.1115/1.4038259 ◽

2017 ◽

Vol 1 (1) ◽

Cited By ~ 6

Author(s):

Che-Yu Lin ◽

Seyedali Sadeghi ◽

Dov A. Bader ◽

Daniel H. Cortes

Keyword(s):

Mechanical Properties ◽

Shear Modulus ◽

Shear Wave ◽

Ulnar Collateral Ligament ◽

Reliability Test ◽

Collateral Ligament ◽

Cronbach’S Alpha ◽

Cronbach's Alpha ◽

Baseball Pitcher

Overhead throwing athletes are at high risk of the elbow ulnar collateral ligament (UCL) injury, and there is a need for clinical tools to objectively diagnose severity of injury and monitor recovery. Mechanical properties of ligaments can potentially be used as biomarkers of UCL health. The objectives of this study are to evaluate the reliability of shear wave ultrasound elastography (SWE) for quantifying UCL shear modulus in 16 healthy nonthrowing individuals and use this technique to evaluate the difference in UCL shear modulus between the injured and uninjured elbows in a baseball pitcher with UCL tear. In the reliability test, the UCL shear modulus of both elbows of each participant was evaluated by SWE for five trials. The same procedures were repeated on two different days. The intra-day and day-to-day reliabilities were determined by the five measurements on the first day and two averages on the two days, respectively. In the case study, each elbow of the baseball pitcher with UCL tear was tested for five trials, and the average was calculated. The intra-day (intraclass correlation coefficient (ICC) = 0.715, Cronbach's alpha = 0.926) and day-to-day (ICC = 0.948, Cronbach's alpha = 0.955) reliabilities were found to be good. There was no difference between both sides. In the case study, the UCL shear modulus of the injured elbow (186.45 kPa) was much lower than that of the uninjured elbow (879.59 kPa). This study shows that SWE could be a reliable tool for quantifying the mechanical properties and health status of the UCL.

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Biomechanical Properties of the Stifle Joint Lateral Collateral Ligament in Dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633103 ◽

1992 ◽

Vol 05 (04) ◽

pp. 158-162 ◽

Cited By ~ 1

Author(s):

D. Blackketter ◽

J Harari ◽

J. Dupuis

Keyword(s):

Mechanical Properties ◽

Cruciate Ligament ◽

Lateral Collateral Ligament ◽

Biomechanical Properties ◽

Fibular Head ◽

Joint Stability ◽

Collateral Ligament ◽

Cranial Cruciate Ligament ◽

Stifle Joint

Bone/lateral collateral ligament/bone preparations were tested and structural mechanical properties compared to properties of cranial cruciate ligament in 15 dogs. The lateral collateral ligament has sufficient stiffness to provide stifle joint stability and strength to resist acute overload following fibular head transposition.

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Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121990052 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199005

Author(s):

Jonathan S. Yu ◽

James B. Carr ◽

Jacob Thomas ◽

Julianna Kostas ◽

Zhaorui Wang ◽

...

Keyword(s):

Social Media ◽

Public Perception ◽

Ulnar Collateral Ligament ◽

Return To Play ◽

Social Media Analytics ◽

Care Providers ◽

Collateral Ligament ◽

The Past ◽

Positive Sentiment ◽

Negative Sentiment

Background: Social media posts regarding ulnar collateral ligament (UCL) injuries and reconstruction surgeries have increased in recent years. Purpose: To analyze posts shared on Instagram and Twitter referencing UCL injuries and reconstruction surgeries to evaluate public perception and any trends in perception over the past 3 years. Study Design: Cross-sectional study. Methods: A search of a 3-year period (August 2016 and August 2019) of public Instagram and Twitter posts was performed. We searched for >22 hashtags and search terms, including #TommyJohn, #TommyJohnSurgery, and #tornUCL. A categorical classification system was used to assess the sentiment, media format, perspective, timing, accuracy, and general content of each post. Post popularity was measured by number of likes and comments. Results: A total of 3119 Instagram posts and 267 Twitter posts were included in the analysis. Of the 3119 Instagram posts analyzed, 34% were from patients, and 28% were from providers. Of the 267 Twitter posts analyzed, 42% were from patients, and 16% were from providers. Although the majority of social media posts were of a positive sentiment, over the past 3 years, there was a major surge in negative sentiment posts (97% increase) versus positive sentiment posts (9% increase). Patients were more likely to focus their posts on rehabilitation, return to play, and activities of daily living. Providers tended to focus their posts on education, rehabilitation, and injury prevention. Patient posts declined over the past 3 years (–28%), whereas provider posts increased substantially (110%). Of posts shared by health care providers, 4% of posts contained inaccurate or misleading information. Conclusion: The majority of patients who post about their UCL injury and reconstruction on social media have a positive sentiment when discussing their procedure. However, negative sentiment posts have increased significantly over the past 3 years. Patient content revolves around rehabilitation and return to play. Although patient posts have declined over the past 3 years, provider posts have increased substantially with an emphasis on education.

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