Biomechanics of a Less Invasive Procedure for Reconstruction of the Ulnar Collateral Ligament of the Elbow

1998 ◽  
Vol 26 (5) ◽  
pp. 620-624 ◽  
Author(s):  
Keith S. Hechtman ◽  
Evert W. Tjin-A-Tsoi ◽  
John E. Zvijac ◽  
John W. Uribe ◽  
Loren L. Latta
Keyword(s):  
Invasive Procedure ◽  
Ulnar Collateral Ligament ◽  
Bone Tunnel ◽  
Peak Strain ◽  
Collateral Ligament ◽  
Bone Anchor ◽  
Reconstruction Methods ◽  
Significant Difference ◽  
The Mean ◽  
Bone Tunnels

A reconstruction of the anterior bundle of the ulnar collateral ligament of the elbow using bone anchors was compared regarding strain and valgus load strength with the intact ulnar collateral ligament and the reconstructed ulnar collateral ligament using bone tunnels. In both normal and reconstructed elbows, the anterior band and posterior band were tight during only a portion of the range of motion. Toward extension, the mean peak strain in the anterior band was tight for the normal and bone anchor groups, but lax in the bone tunnel group. Toward extension, the mean peak strain in the posterior band was lax in all elbows. Toward flexion, the strain in the anterior band was lax in the normal and bone anchor groups, but tight in the bone tunnel group. The mean of the peak strains for the posterior band toward flexion was tight for all elbows. Mean valgus load strength of normal elbows was 22.7 9.0 N m. The bone tunnel and bone anchor mean strengths were 76.3% and 63.5%, respectively, of normal elbow strength. We concluded that the bone anchor reproduced the normal anatomy and mechanical function of the ulnar collateral ligament more closely than the bone tunnel, and that both reconstruction methods were significantly weaker than the normal ulnar collateral ligament. However, we found no significant difference in reconstruction strength between bone anchor and bone tunnel.

Baseball Players With an Ulnar Collateral Ligament Tear Display Increased Nondominant Arm Humeral Torsion Compared With Healthy Baseball Players

2016 ◽  
Vol 45 (1) ◽  
pp. 144-149 ◽  
Author(s):  
Casey J. Meyer ◽  
J. Craig Garrison ◽  
John E. Conway
Keyword(s):  
Ulnar Collateral Ligament ◽  
Protective Mechanism ◽  
Shoulder Injuries ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Elbow Injury ◽  
Significant Difference ◽  
Humeral Torsion ◽  
The Mean ◽  
The Relationship

Background: Previous work has suggested that an increase in the amount of developmentally acquired, dominant arm humeral retrotorsion (D HRT) in the thrower’s shoulder may be a potentially protective mechanism. Although the relationship between HRT and shoulder injuries has been reported, the relationship between HRT and ulnar collateral ligament (UCL) tears in baseball players is not known. Purpose: To determine whether D HRT and nondominant arm HRT (ND HRT) measurements in baseball players with a UCL tear differ statistically from a matched healthy cohort. Study Design: Case-control study; Level of evidence, 3. Methods: D HRT and ND HRT were measured in 112 male competitive high school and collegiate baseball players seen over an 18-month period from 2013 to 2015. A total of 56 participants with a clinical and magnetic resonance imaging–confirmed diagnosis of a throwing-arm UCL tear (UCLInj group) were compared with 56 healthy baseball players with no history of an elbow injury who were matched for age, experience, and position (NUCLInj group). The mean ages in the UCLInj and NUCLInj groups were 17.9 ± 2.2 and 17.6 ± 2.8 years, respectively. Using a previously validated ultrasound method, D HRT and ND HRT were measured in the supine position, and the HRT side-to-side difference (D HRT – ND HRT) was calculated. A 1-way multivariate analysis of variance was used to determine the mean statistical differences between groups ( P < .05). Results: Baseball players with a UCL tear displayed significantly more humeral torsion (ie, less retrotorsion) in their nondominant arm compared with healthy baseball players (UCLInj = 33.27° ± 10.27°, NUCLInj = 27.82° ± 10.88°; P = .007). Baseball players with a UCL tear did not display any differences in D HRT compared with healthy baseball players (UCLInj = 18.67° ± 9.41°, NUCLInj = 17.09° ± 9.92°; P = .391). Significant side-to-side differences in HRT existed between groups (UCLInj = −14.60° ± 6.72°, NUCLInj = −10.72° ± 6.88°; P = .003). Conclusion: There was a significant increase in mean nondominant arm humeral torsion (ie, less retrotorsion) in the UCL tear group, but there was no significant difference in the mean D HRT between the injured and uninjured groups. A greater HRT side-to-side difference was displayed in the UCL tear group. The extent to which a thrower has developmentally acquired both D HRT and ND HRT may affect elbow UCL tear risk. Furthermore, it is possible that the extent of genetically predisposed ND HRT may influence the throwing-related increase in D HRT.

scholarly journals Ulnar Collateral Ligament Reconstruction With the Modified Jobe Technique in Baseball Pitchers

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199833
Author(s):  
Masahito Yoshida ◽  
Tetsuya Takenaga ◽  
Satoshi Takeuchi ◽  
Keishi Takaba ◽  
Atsushi Tsuchiya ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Clinical Results ◽  
Bone Tunnel ◽  
Reconstruction Technique ◽  
Return To Sports ◽  
Collateral Ligament ◽  
Imaging Results ◽  
The Mean ◽  
Baseball Pitchers

Background: Tearing and insufficiency of the ulnar collateral ligament (UCL) of the elbow result in valgus instability, which can lead to pain while throwing and decline in performance in overhead athletes. Purpose: To assess the clinical results of a modified UCL reconstruction technique using 1 bone hole in the ulna and 1 bone tunnel in the humerus in baseball players. Study Design: Case series; Level of evidence, 4. Methods: The inclusion criteria were medial elbow pain preventing effective playing, clinically medial elbow laxity, and magnetic resonance imaging results consistent with UCL injury. Patients who were engaged in other sports and in other positions in baseball except pitchers were excluded from this study. Our modified Tommy John procedure was performed via a muscle-splitting approach and an original single-bone-tunnel technique, using a suture anchor. After a minimum of 24 months, patients were evaluated using the Conway scale and the Timmerman-Andrews score. Results: Of 31 patients, 20 baseball pitchers (20 male: 5 high school, 5 collegiate, 8 nonprofessional, and 2 professional pitchers) were reviewed. The mean patient age at the time of operation was 21.9 years, and the mean postoperative follow-up period was 35.1 months (range, 24-66 months). The mean Timmerman-Andrews subjective score improved significantly from pre- to postoperatively (from 68.3 to 98.3; P < .05); the objective score also improved significantly (from 81.1 to 96.4; P = .01). No complications were detected at the latest follow-up. Overall, 19 patients were able to return to their preinjury level of sports or higher. Conclusion: UCL reconstruction with 1 bone hole in the ulna and 1 bone tunnel in the humerus demonstrated satisfactory results in baseball pitchers. Our modified technique was safe and achieved satisfactory clinical results, with a 95% rate of return to sports.

scholarly journals BONE TUNNEL ENLARGEMENT WITH NON-METALLIC INTERFERENCE SCREWS IN ACL RECONSTRUCTION

2018 ◽  
Vol 26 (5) ◽  
pp. 305-308 ◽  
Author(s):  
Vitor Barion Castro de Padua ◽  
Júlio Cesar Rodrigues Vilela ◽  
Wendel Aculha Espindola ◽  
Rafael Cassiolato Garcia Godoy
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Tibial Tunnel ◽  
Bone Tunnel ◽  
Tunnel Enlargement ◽  
Interference Screws ◽  
Bone Tunnel Enlargement ◽  
Reconstruction Methods ◽  
Significant Difference ◽  
Bone Tunnels

ABSTRACT Objective: To compare the widening of bone tunnels between poly-etheretherketone (PEEK), absorbable polylactic acid DL (PLDL) and tricalcium phosphate (TCP) interference screws in anterior cruciate ligament (ACL) reconstruction. Methods: Three groups of patients undergoing ACL reconstruction with at least 1 year of follow-up using the out-in drilling technique and hamstring as a graft were assessed. The patients were divided according to the type of interference screw used (PEEK, PLDL and TCP). Computed tomography (CT) was performed to measure the greatest femoral and tibial tunnel widening regarding to the initial tunnel, and then it was compared between groups. Results: Mean widening in group 1 (PEEK) was 39.56% (SD 16%) in the femoral tunnel and 33.65% (SD 20%) in the tibia. In group 2 (PLDL) mean widening was 48.43% in the femoral tunnel (SD 18%) and 35.24% (SD 13%) in the tibial tunnel. In group 3 (TCP) mean widening was 44.51% in the femur (SD 14%) and 36.83% in the tibia (SD 14%). The comparison between groups (PLDL-PEEK, PLDL-TCP, PEEK-TCP) shows no statistically significant difference. Conclusion: Bone tunnel enlargement values after ACL reconstruction with the use of different types of materials (bioinert and biomaterials) of interference screws (PEEK, PLDL and TCP) were similar. Level of Evidence III, Comparative retrospective study.

scholarly journals Isometric Tunnel Placement in Ulnar Collateral Ligament Reconstruction with Single CT Scan

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Erica Kholinne ◽  
Rizki Fajar Zulkarnain ◽  
Arnold Adikrishna ◽  
Bin Zhu ◽  
Han Pyo Hong ◽  
...  
Keyword(s):  
Ct Scan ◽  
Three Dimensional ◽  
Ulnar Collateral Ligament ◽  
Bone Tunnel ◽  
Ct Scans ◽  
Tunnel Placement ◽  
Collateral Ligament ◽  
Significant Difference ◽  
Three Dimensional Models ◽  
Preoperative Plan

Background. Isometric tunnel placement for anterior bundle of the medial collateral ligament (MCL) reconstruction is mandatory for successful surgery. Purpose. This study aimed to demonstrate a useful method for identifying isometric tunnel placement using a single computed tomography (CT) scan. Study Design. Descriptive Laboratory Study. Methods. Five normal elbows were scanned at 4 different flexion angles at 45° increment. Three-dimensional models were analyzed using 2 different approaches: single and multiple CT scans methods. Ligament footprints in the humerus and the ulna were registered. Ligament length and isometric points were defined. The locations of the isometric points were imported into both methods to be compared. Results. There was no significant difference between 2 methods in calculating the length in every zone. There was also no significant difference in determining isometric ligament’s origin point, which is located approximately 18.2±4.0 mm and 18.4±2.9 mm for single and multiple CT, respectively, measured inferolaterally from medial epicondyle. Conclusions. A solid preoperative plan is critical when predicting tunnel locations due to the difficulty in finding isometric points and the individuality of optimal bone tunnel locations. Using single CT scan, optimal locations can be predicted with the same accuracy as a multiple CT scans with less radiation exposure.

A New Technique for Reconstruction of the Ulnar Collateral Ligament of the Thumb

2007 ◽  
Vol 35 (8) ◽  
pp. 1321-1325 ◽  
Author(s):  
Michael A. Baskies ◽  
David Tuckman ◽  
Nader Paksima ◽  
Martin A. Posner
Keyword(s):  
Testing Machine ◽  
Proximal Phalanx ◽  
Peak Load ◽  
Ulnar Collateral Ligament ◽  
Surgical Reconstruction ◽  
Materials Testing ◽  
Collateral Ligament ◽  
Peak Loads ◽  
Reconstruction Methods ◽  
Significant Difference

Background Several previous studies have described reconstructive methods for the treatment of an injury to the ulnar collateral ligament of the thumb. However, there are few biomechanical studies to date to analyze the strength of the surgical reconstruction. Purpose To evaluate 2 reconstruction techniques with use of a cadaveric model (1) reconstruction with the use of a free tendon graft placed in a figure-of-8 fashion through drill holes in the metacarpal and proximal phalanx of the thumb, and (2) reconstruction with the use of the Bio-Tenodesis Screw System. Study Design Controlled laboratory study. Methods Eight matched pairs of cadaveric specimens underwent removal of the proper and accessory ulnar collateral ligaments. One of the 2 reconstruction methods was performed, and specimens were mounted on a materials-testing machine. The specimens were subjected to valgus stress to failure at 30° of flexion. Failure was defined as valgus laxity of 30° at the metacarpophalangeal joint. Results The peak load to failure was 23.5 ± 11.4 N for the figure-of-8 reconstruction and 24.3 ± 12.3 N for the reconstruction using the Bio-Tenodesis Screw System. Comparing the 2 groups, there was no statistically significant difference in peak loads to failure (P = .88). Conclusion There was no statistically significant difference between the peak loads to failure of the 2 reconstructions. Clinical Relevance The Bio-Tenodesis Screw System may provide another viable option for surgical reconstruction of the ulnar collateral ligament of the thumb.

scholarly journals Effect of Ulnar Collateral Ligament Reconstruction on Pitch Accuracy, Velocity, and Movement in Major League Baseball Pitchers

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096853
Author(s):  
Braden McKnight ◽  
Nathanael D. Heckmann ◽  
Xiao T. Chen ◽  
Kevork Hindoyan ◽  
J. Ryan Hill ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Poor Performance ◽  
Return To Play ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Major League ◽  
The Mean ◽  
Performance Statistics

Background: Ulnar collateral ligament (UCL) reconstruction is frequently performed on Major League Baseball (MLB) pitchers. Previous studies have investigated the effects of UCL reconstruction on fastball and curveball velocity, but no study to date has evaluated its effect on fastball accuracy or curveball movement among MLB pitchers. Purpose/Hypothesis: The primary purpose of this study was to determine the effects of UCL reconstruction on fastball accuracy, fastball velocity, and curveball movement in MLB pitchers. Our hypothesis was that MLB pitchers who underwent UCL reconstruction would return to their presurgery fastball velocity, fastball accuracy, and curveball movement. The secondary purpose of this study was to determine which factors, if any, were predictive of poor performance after UCL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: MLB pitchers who underwent UCL reconstruction surgery between 2011 and 2012 were identified. Performance data including fastball velocity, fastball accuracy, and curveball movement were evaluated 1 year preoperatively and up to 3 years of play postoperatively. A repeated-measures analysis of variance with a Tukey-Kramer post hoc test was used to determine statistically significant changes in performance over time. Characteristic factors and presurgery performance statistics were compared between poor performers (>20% decrease in fastball accuracy) and non—poor performers. Results: We identified 56 pitchers with a total of 230,995 individual pitches for this study. After exclusion for lack of return to play (n = 14) and revision surgery (n = 3), 39 pitchers were included in the final analysis. The mean presurgery fastball pitch-to-target distance was 32.9 cm. There was a statistically significant decrease in fastball accuracy after reconstruction, which was present up to 3 years postoperatively ( P = .007). The mean presurgery fastball velocity of 91.82 mph did not significantly change after surgery ( P = .194). The mean presurgery curveball movement of 34.49 cm vertically and 5.89 cm horizontally also did not change significantly ( P = .937 and .161, respectively). Conclusion: Fastball accuracy among MLB pitchers significantly decreased after UCL reconstruction for up to 3 years postoperatively. There were no statistically significant differences in characteristic factors or presurgery performance statistics between poor and non--poor performers.

Effect of Younger Starting Pitching Age on Humeral Retrotorsion in Baseball Pitchers With an Ulnar Collateral Ligament Injury

2021 ◽  
pp. 036354652199080
Author(s):  
Sean M. Kennedy ◽  
Joseph P. Hannon ◽  
John E. Conway ◽  
Kalyssa Creed ◽  
J. Craig Garrison
Keyword(s):  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Significant Difference ◽  
Ulnar Collateral Ligament Injury ◽  
Baseball Pitchers ◽  
Group 2 ◽  
Group 1

Background: Increased humeral retrotorsion (HRT) has been found to be a risk factor for ulnar collateral ligament (UCL) tears in baseball players. Recent work has demonstrated the age of 11 years as a potential watershed age for HRT development. Hypothesis: In a group of baseball pitchers with UCL injuries, athletes who started pitching before the age of 10 years will demonstrate significantly more dominant limb humeral retrotorsion (DHRT) when compared with a group of baseball pitchers who reported starting pitching at 10 years or older. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 84 baseball pitchers with a diagnosed UCL injury were divided into 2 groups based upon the age at which participants began pitching: 33 players reporting a starting pitching age of 10 years or older (group 1) were compared with 51 baseball pitchers reporting a starting pitching age under 10 years (group 2). Participants’ DHRT and nondominant limb humeral retrotorsion (NDHRT) were measured using diagnostic ultrasound. Independent t tests were run to compare mean group differences of all patient data, starting pitching age, age at time of injury, DHRT, NDHRT, and humeral retrotorsion difference (HRTdiff). Results: There were no significant differences between groups with regard to age at time of injury, height, weight, or playing years’ experience. There was a statistically significant difference in the participant-reported starting pitching age. Significant differences between groups were noted for DHRT (group 1: 20.0°± 9.4°, group 2: 14.5°± 10.3°, P = .015) and for NDHRT (group 1: 38.6°± 8.8°, group 2: 32.9°± 9.5°, P = .007). No significant differences between groups were found for HRTdiff ( P = .940). Conclusion: Baseball pitchers with a UCL injury who reported a starting pitching age younger than 10 years demonstrated significantly greater DHRT and NDHRT when compared with UCL-injured baseball pitchers who reported a starting pitching age at 10 years or later. The results of this study demonstrate that a younger starting pitching age results in increased HRT in players with UCL injuries.

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 Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095914
Author(s):  
Justin C. Kennon ◽  
Erick M. Marigi ◽  
Chad E. Songy ◽  
Chris Bernard ◽  
Shawn W. O’Driscoll ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Ulnar Neuropathy ◽  
Complication Rates ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Functional Scores ◽  
The Mean

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

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