Internal Bracing Augmentation of the Ulnar Collateral Ligament on a Level 10 Competitive Gymnast: A Case Study

2021 ◽  
pp. 1-6
Author(s):  
Dana Vander Wal ◽  
Brenda Potter ◽  
Shannon L. David ◽  
Nicole German
Keyword(s):  
Conventional Treatment ◽  
Ulnar Collateral Ligament ◽  
Nonoperative Treatment ◽  
Collateral Ligament ◽  
Overhead Athletes ◽  
The Sublime ◽  
Internal Bracing ◽  
Internal Brace ◽  
Grade 3

Ulnar collateral ligament (UCL) injuries have become increasingly more common over the years. Reconstruction and nonoperative treatment have been the conventional treatment for athletes, especially for overhead athletes. This case study presents a 16-year-old female, competitive Level 10 gymnast, with a complete distal tear of her UCL with a full thickness, Grade 3, ulnar sided avulsion off of the sublime tubercle. She underwent medial UCL repair with internal brace augmentation with the goal of faster return to gymnastics. To the author’s knowledge, this is the second gymnast reported in the literature to have an internal brace augmentation completed on the UCL.

scholarly journals Biomechanical Evaluation of a Modified Internal Brace Construct for the Treatment of Ulnar Collateral Ligament Injuries

2019 ◽  
Vol 7 (10) ◽  
pp. 232596711987413 ◽  
Author(s):  
Ekaterina Urch ◽  
Orr Limpisvasti ◽  
Neal S. ElAttrache ◽  
Yasuo Itami ◽  
Michelle H. McGarry ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Reconstruction Technique ◽  
Full Extension ◽  
Failure Characteristics ◽  
Intact State ◽  
The Sublime ◽  
Load To Failure ◽  
Internal Bracing ◽  
Internal Brace ◽  
Reconstruction Group

Background: Ulnar collateral ligament (UCL) repair augmented with the “internal brace” construct for the management of acute UCL injuries has recently garnered increasing interest from the sports medicine community. One concern with this technique is excessive bone loss at the sublime tubercle, should revision UCL reconstruction be required. In an effort to preserve the bony architecture of the sublime tubercle, an alternative internal brace construct is proposed and biomechanically compared with the gold standard UCL reconstruction. Hypothesis: The internal brace repair construct will restore valgus laxity and rotation to its native state and demonstrate comparable load-to-failure characteristics with the 3-strand reconstruction technique. Study Design: Controlled laboratory study. Methods: For this study, 8 matched pairs of fresh-frozen cadaveric elbows were randomized to undergo either UCL reconstruction with the 3-ply docking technique or UCL repair with a novel internal brace construct focused on augmenting the posterior band of the anterior bundle of the ligament (modified repair-IB technique). Valgus laxity and rotation measurements were quantified through use of a MicroScribe 3DLX digitizer at various flexion angles of the native ligament, transected ligament, and repaired or reconstructed ligament. Laxity testing was performed from maximum extension to 120° of flexion. Each specimen was then loaded to failure, and the method of failure was recorded. Results: Valgus laxity was restored to the intact state at all degrees of elbow flexion with the modified repair-IB technique, and rotation was restored to the intact state at both full extension and 30°. In the reconstruction group, valgus laxity was not restored to the intact state at either full extension or 30° of flexion ( P < .001 and P = .004, respectively). Laxity was restored at 60° of flexion, but the elbow was overconstrained at 90° and 120° of flexion ( P = .027 and P = .003, respectively). In load-to-failure testing, the reconstruction group demonstrated significantly greater yield torque (19.1 vs 9.0 N·m; P < .005), yield angle (10.2° vs 5.4°; P = .007), and ultimate torque (23.9 vs 17.6 N·m; P = .039). Conclusion: UCL repair with posterior band internal bracing was able to restore valgus laxity and rotation to the native state. The construct exhibited lower load-to-failure characteristics when compared with the reconstruction technique. Clinical Relevance: In selected patients with acute, avulsion-type UCL injuries, ligament repair with posterior band internal bracing is a viable alternative surgical option that, by preserving bone at the sublime tubercle, may decrease the complexity of future revision procedures.

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

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110142
Author(s):  
Robert O’Connell ◽  
Marcus Hoof ◽  
John Heffernan ◽  
Michael O’Brien ◽  
Felix Savoie
Keyword(s):  
Functional Outcomes ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Orthopaedic Clinic ◽  
Overhead Athletes ◽  
Internal Brace ◽  
The Mean

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.

Ulnar Collateral Ligament Repair With Collagen-Dipped FiberTape Augmentation in Overhead-Throwing Athletes

2019 ◽  
Vol 47 (5) ◽  
pp. 1096-1102 ◽  
Author(s):  
Jeffrey R. Dugas ◽  
Christopher A. Looze ◽  
Brian Capogna ◽  
Brian L. Walters ◽  
Christopher M. Jones ◽  
...  
Keyword(s):  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Final Decision ◽  
Collateral Ligament ◽  
Tissue Quality ◽  
Level Of Evidence ◽  
Overhead Athletes ◽  
Novel Technique ◽  
Internal Brace

Background: There has been a renewed interest in ulnar collateral ligament (UCL) repair in overhead athletes because of a greater understanding of UCL injuries, an improvement in fixation technology, and the extensive rehabilitation time to return to play. Purpose/Hypothesis: To evaluate the clinical outcomes of a novel technique of UCL repair with internal brace augmentation in overhead throwers. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing a novel technique of UCL repair with internal brace augmentation were prospectively followed for a minimum of 1 year. Potential candidates for repair were selected after the failure of nonoperative treatment when imaging suggested a complete or partial avulsion of the UCL from either the sublime tubercle or medial epicondyle, without evidence of poor tissue quality of the ligament. The final decision on UCL repair or traditional reconstruction was determined intraoperatively. Demographic and operative data were collected at the time of surgery. Return to play, and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores were collected at 1 year and then again at 2 years postoperatively. Results: Of the 111 overhead athletes eligible for the study, 92% (102/111) of those who desired to return to the same or higher level of competition were able to do so at a mean time of 6.7 months. These patients had a mean KJOC score of 88.2 at final follow-up. Conclusion: UCL repair with internal brace augmentation is a viable option for amateur overhead throwers with selected UCL injuries who wish to return to sport in a shorter time frame than allowed by traditional UCL reconstruction.

RADIOLOGIC CASE STUDY: Ulnar collateral ligament injury

Orthopedics ◽  
1998 ◽  
Vol 21 (7) ◽  
pp. 827-827
Author(s):  
Franklin Tan ◽  
Laurie M Lomasney ◽  
Terence C Demos
Keyword(s):  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Ulnar Collateral Ligament Injury

scholarly journals Comparative Analysis of the Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries in Professional Baseball Players with and without Platelet-Rich Plasma

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008 ◽  
Author(s):  
Peter Douglas McQueen ◽  
Christopher L. Camp ◽  
Aakash Chauhan ◽  
Brandon J. Erickson ◽  
Hollis G. Potter ◽  
...  
Keyword(s):  
Recovery Time ◽  
Platelet Rich Plasma ◽  
Ulnar Collateral Ligament ◽  
Nonoperative Treatment ◽  
Return To Play ◽  
Professional Baseball ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Minor League Baseball ◽  
Minor League

Objectives: In the setting of ulnar collateral ligament (UCL) injury, surgical reconstruction of the UCL is not always selected, as it leads to a prolonged recovery time and return to play rates between 67-95%. To date, there is limited data on outcomes following nonoperative treatment in this population. Orthobiologics, such as platelet-rich plasma (PRP), have recently been used as an adjunct therapy for standard nonoperative treatment including rest and physical therapy for UCL injuries. The objective of this study was to determine if the addition of PRP injections in professional baseball players with UCL injuries reduces recovery time, lowers the likelihood of surgery, and increases the return to play rate compared to traditional nonoperative treatment. Methods: The Health and Injury Tracking System (HITS) database was searched from 2011-2015 for Major and Minor league baseball players with Grade I, II or III UCL injuries. Standard demographic, injury, and return to play data was obtained for all players. MRI’s for 353 athletes were reviewed by a musculoskeletal radiologist and graded accordingly. Outcomes were compared between players who received PRP injections in addition to traditional nonoperative treatment (PRP group) and players who received traditional nonoperative treatment alone (No PRP group). Statistical analysis was performed using Student’s T-test and Chi-square for parametric data. Kaplan Meier’s analysis was used for estimating longevity of the treatment. Results: A total of 544 Major and Minor League Baseball players with UCL tears underwent an initial course of nonoperative treatment (active rest & rehabilitation) for their injury between 2011-2015. Of these, 133 underwent PRP injections plus rehab and 411 underwent rehab alone. There was a significantly higher proportion of Major League Baseball players in the PRP group compared to the No PRP group (25.6% vs 9.0%, P<0.001). There was no difference between the two cohorts in regard to the grade of UCL tear (Figure 1). The players in the PRP group had a significantly longer time before returning to a throwing program compared to the No PRP group (64 days vs 51 days, P<0.001). The mean time from injury date to PRP injection was 14.5 days, which may explain the difference in time to return to throwing. The return to play rate in a live game without surgery was significantly lower in the PRP group compared to the No PRP group (46% vs 57%, P=0.03). There was no difference in the proportion of athletes requiring UCL reconstruction (58% vs 51%) or the time to surgery (154 days vs 178 days) between the two groups. Kaplan Meier survivor analysis showed no difference between the PRP and No PRP groups with regard to longevity of the native UCL (Figure 2). Conclusion: Among Major and Minor League Baseball players who were treated nonoperatively for a UCL injury between 2011-2015, 24% underwent PRP injections prior to rehab. Compared to traditional nonoperative rehab alone program, players who received PRP injections experienced a significantly longer time before returning to throwing, which may be in part due to the delay between the injury date and PRP injection. PRP injections did not appear to have a significant effect on the likelihood of surgical intervention.

scholarly journals Direct Comparison of Modified Jobe and Docking Ulnar Collateral Ligament Reconstruction at Midterm Follow-up

2018 ◽  
Vol 47 (1) ◽  
pp. 144-150 ◽  
Author(s):  
Justin W. Arner ◽  
Edward S. Chang ◽  
Stephen Bayer ◽  
James P. Bradley
Keyword(s):  
Reconstructive Surgical Procedures ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Shoulder Injuries ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Overhead Athletes ◽  
Additional Surgery ◽  
Significant Difference

Background: The modified Jobe and docking techniques are the 2 most commonly employed techniques for ulnar collateral ligament (UCL) reconstruction among overhead athletes. However, no study has directly compared these techniques performed by a single surgeon. Current comparisons of these techniques have relied solely on systematic reviews and biomechanical studies. Hypothesis: There will be no difference in outcomes or return to play between the modified Jobe and docking techniques in elbow UCL reconstruction surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-five modified Jobe and 26 docking UCL-reconstructive surgical procedures were performed by a single surgeon, each with a minimum 2-year follow-up. Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway Scale, years played, sex, handedness, sport, position, palmaris versus gracilis graft type, concomitant or future arm/shoulder injuries, and need for additional surgery were compared between the groups. Patients who underwent future shoulder or elbow surgery, no matter the cause, were included. Results: No difference was seen between the modified Jobe and docking reconstruction cases in regard to KJOC scores (mean ± SD: 78.4 ± 19.5 vs 72.0 ± 26.0, P = .44), Conway Scale (return to play, any level: 84% vs 82%, P = .61), years played (14.7 ± 6.2 vs 15.2 ± 5.8, P = .52), sex ( P = .67), handedness ( P ≥ .999), sport ( P = .44), position ( P = .60), level of competition ( P = .59), and future surgery (12% vs 4%, P = .35). Palmaris graft type had significantly higher KJOC scores than hamstring grafts (82.3 ± 20.0 vs 57.9 ± 21.2, P = .001). The mean follow-up was 6.1 years in the modified Jobe group and 7.3 years in the docking group (mean = 6.7, P = .47). Conclusion: The modified Jobe and docking techniques are both suitable surgical options for elbow UCL reconstruction. There was no statistically significant difference between the techniques in regard to return to play, KJOC score, or need for subsequent surgery at 6.7-year follow-up. This is the first direct clinical comparison of these 2 techniques by a single surgeon at midterm follow-up.

scholarly journals Ulnar Collateral Ligament Repair with Internal Brace Augmentation in Amateur Overhead Throwing Athletes

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008 ◽  
Author(s):  
Jeffrey R. Dugas ◽  
Christopher A. Looze ◽  
Christopher Michael Jones ◽  
Brian L. Walters ◽  
Marcus A. Rothermich ◽  
...  
Keyword(s):  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Time Frame ◽  
Return To Play ◽  
Overhead Athletes ◽  
Late Failure ◽  
Internal Brace ◽  
Overhead Throwing ◽  
A Prospective Study

Objectives: There has been a renewed interest in UCL repair in overhead athletes. This is largely due to greater understanding of UCL pathology, improvement in fixation technology and the extensive rehab required to return from UCL reconstruction. Initial data regarding UCL repair in overhead athletes was poor and therefore UCL repair was largely abandoned in favor of reconstruction. However, recent literature examining UCL repair with anchor only fixation demonstrated an excellent rate of return to play, reduced time to return to play and a low complication rate. Based on this promising data, we have developed a novel technique of UCL repair with internal brace augmentation that we have used in overhead throwing athletes. We performed a prospective study evaluating the outcomes of this procedure with respect to return to play, time to return to play, functional outcome score and complications. Methods: Overhead athletes undergoing UCL repair with internal brace augmentation were prospectively followed for a minimum of one year. Patients were carefully selected from those who would traditionally be considered for UCL reconstruction. Initially, patients were considered if they had an avulsion of the UCL with otherwise healthy UCL tissue and had a vested interest in shortened rehab. As the study progressed, interest in shortened rehab became a less stringent criteria. Demographic and operative data were collected at the time surgery. This data was compiled for both desciption and comparison between subgroups. Patients were then contacted 1 year postoperatively and assessed for return to play, time to return to play and KJOC scores. Complications were documented and patients having complications were detailed. Results: 66 overhead athletes underwent UCL repair with internal brace augmentation during the study period. 8 were lost to follow up, leaving 58 athletes included in the study. Average age at the time of surgery was 17.9 years old. There were 43 baseball pitchers, 8 baseball position players, 4 softball players, 2 football quaterbacks, and 1 javelin thrower. 96% (54/56) of those who desired to return to the same or higher level of competition were able to do so at an average time of 6.1 months (range 3.2-12 months). 65% of these were able to return in less than 6 months. Many of those who took longer than 6 months did so due to timing within the season. Average KJOC score was 90.2 at 1-year follow-up. 3 patients required return to the operating room, 2 of which were eventually able to return to their previous level of play. There was 1 late failure over 3 years from the index procedure. Comparative subgroup data is presented in table 1. Conclusion: UCL repair with internal brace augmentation is a viable option for overhead throwers with selected UCL pathology who wish to return to sport in a shorter time frame than allowed by traditional UCL reconstruction. [Table: see text]

Repair of the Ulnar Collateral Ligament of the Elbow: Rehabilitation Following Internal Brace Surgery

2019 ◽  
Vol 49 (4) ◽  
pp. 253-261 ◽  
Author(s):  
Kevin E. Wilk ◽  
Christopher A. Arrigo ◽  
Michael S. Bagwell ◽  
Marcus A. Rothermich ◽  
Jeffrey R. Dugas
Keyword(s):  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Internal Brace

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

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983978 ◽  
Author(s):  
Prem N. Ramkumar ◽  
Heather S. Haeberle ◽  
Sergio M. Navarro ◽  
Salvatore J. Frangiamore ◽  
Lutul D. Farrow ◽  
...  
Keyword(s):  
Classification System ◽  
Odds Ratio ◽  
Clinical Utility ◽  
Nonoperative Management ◽  
Ulnar Collateral Ligament ◽  
Nonoperative Treatment ◽  
Rehabilitation Program ◽  
Collateral Ligament ◽  
Baseball Players

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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