scholarly journals The Effect of Ulnar Collateral Ligament Repair With Internal Brace Augmentation on Articular Contact Mechanics: A Cadaveric Study

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110010
Author(s):  
Travis S. Roth ◽  
David P. Beason ◽  
T. Bradley Clay ◽  
E. Lyle Cain ◽  
Jeffrey R. Dugas
Keyword(s):  
Contact Mechanics ◽  
Elbow Joint ◽  
Angular Displacement ◽  
Ulnar Collateral Ligament ◽  
Biomechanical Properties ◽  
Joint Torque ◽  
Return To Play ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Intact State

Background: There has been renewed interest in ulnar collateral ligament (UCL) repair in throwing athletes because of a greater understanding of UCL injuries, improvement in ligament repair technology, and potentially expedited rehabilitation time and return to play relative to UCL reconstruction. Purpose: To evaluate elbow articular contact and overall joint torque after UCL reconstruction and repair augmented with a collagen-coated fiber tape, InternalBrace. Study Design: Controlled laboratory study. Methods: Ten matched pairs of cadaveric arms (mean age, 41 ± 11 years) were dissected to expose the UCL. Each specimen was secured into a custom test fixture at 90°, and 1 specimen from each pair underwent either a modified Jobe UCL reconstruction or UCL repair with InternalBrace. Each specimen underwent 10 cycles of elbow valgus angular displacement between 0° and 5° at a rate of 1 deg/s in the intact state, after UCL avulsion, and then after UCL reconstruction or repair. Articular contact mechanics and overall joint torque and stiffness were recorded. Results: Contact mechanics of reconstructed and repaired specimens were not significantly different. Both reconstruction and repair procedures returned the overall resistance of the joint to valgus torsion to near-intact levels. UCL repair tended to restore joint torque more closely to the intact state than did reconstruction, given that reconstruction showed a nonsignificant trend toward lower torque than the intact state ( P = .07). Conclusion: Neither UCL reconstruction nor UCL repair with InternalBrace overconstrained the elbow joint, as both groups had similar contact pressures compared with the native joint. Both procedures also restored elbow joint torque and stiffness to levels not statistically different from the intact state. Clinical Relevance: Given the sound biomechanical properties of UCL repair with InternalBrace, it may have a significant role as treatment for UCL injuries.

Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction With a Modified Docking Technique With and Without Suture Augmentation

2019 ◽  
Vol 47 (4) ◽  
pp. 928-932 ◽  
Author(s):  
Jeremi Leasure ◽  
Kerisimasi Reynolds ◽  
Marc Thorne ◽  
Rafael Escamilla ◽  
Ken Akizuki
Keyword(s):  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Reconstruction Technique ◽  
Gap Formation ◽  
Collateral Ligament ◽  
Intact State ◽  
Time Zero ◽  
Load To Failure ◽  
Bone Tunnels ◽  
Reconstruction Group

Background: Throwing athletes with ulnar collateral ligament (UCL) injury and symptomatic valgus instability can expect to return to the same or higher level of play. Reconstruction with tendon graft is the dominant method of surgical treatment. Recent evidence suggests that spanning the joint with a suture anchored on both sides is biomechanically equivalent to reconstruction, with faster time to return to play. The authors developed a hybrid UCL reconstruction technique augmented with a suture brace to improve joint stability. Purpose/Hypothesis: The purpose of this study was to biomechanically evaluate a hybrid reconstruction technique and compare its performance to reconstruction without augmentation. The authors hypothesized that (1) both groups would lose stability after the simulated tear and regain stability with treatment, (2) the suture augmentation would improve stability, and (3) the addition of the suture anchors near the bone tunnels would not decrease the strength of the hybrid reconstruction. Study Design: Controlled laboratory study. Methods: Ten matched pairs of cadaveric arms were dissected to expose the UCL. Each elbow was mounted on a test frame at 90° of flexion. A cyclic valgus rotational torque was applied to the humerus with the UCL in its intact state and repeated in its surgically torn state. Finally, each specimen received either a hybrid reconstruction with suture brace or a reconstruction and was again put through the cyclic protocol, followed by a valgus rotation load-to-fail protocol. Results: Gap formation in the torn state for the reconstruction and hybrid reconstruction groups (0.9 ± 0.1 mm and 0.8 ± 0.1 mm, respectively) was significantly higher ( P = .009 and P = .0002) than in the intact state (0.6 ± 0.2 mm and 0.6 ± 0.3 mm, respectively). After the procedures, the hybrid group showed greater resistance to gapping ( P = .017) as compared with the reconstruction group (0.4 ± 0.2 mm and 0.6 ± 0.1 mm). During load to failure, no hybrid reconstructions failed from bone fracture or screw pullout. No statistical differences were found for failure torque ( P = .058) and stiffness ( P = .101). Gap at 10 N·m was significantly lower ( P = .014) for the hybrid reconstruction group than for the reconstruction group. Conclusion: The current study showed that hybrid reconstruction with suture bracing replicated the time-zero strength of traditional UCL reconstruction and may be more resistant to joint gapping during low cyclic load and load to failure. The combination of the bone tunnels and fixation screw holes did not appear to weaken the construct. Clinical Relevance: This study demonstrated that reconstruction with suture bracing has important time-zero stability and strength as compared with the gold standard of UCL reconstruction. This technique may be useful for throwing athletes who need UCL reconstruction.

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

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.

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.

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 Arthroscopically-assisted fixation of anteromedial coronoid facet fracture and lateral ulnar collateral ligament repair for acute posteromedial rotatory fracture dislocation of the elbow

2017 ◽  
Vol 11 (5) ◽  
pp. 378-383 ◽  
Author(s):  
Abbas Rashid ◽  
David Copas ◽  
Jeremy Granville-Chapman ◽  
Adam Watts
Keyword(s):  
Articular Surface ◽  
Ulnar Collateral Ligament ◽  
Fracture Dislocation ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Coronoid Fracture ◽  
Elbow Arthroscopy ◽  
Lateral Ulnar Collateral Ligament ◽  
Arthroscopically Assisted ◽  
Facet Fracture

If left untreated, varus posteromedial rotatory injuries of the elbow result in poor functional outcomes. Surgical treatment allows restoration of elbow kinematics, minimizing the chances of chronic varus instability and early onset osteoarthritis. However, large exposures are associated with extensive soft tissue stripping, a high risk of infection, nerve injury, poor visualization of the articular surface and longer recovery. Consequently, there has been renewed interest in the use of elbow arthroscopy to circumvent these problems. Arthroscopic treatment offers the potential advantage of a swift recovery, with instant rehabilitation, less stiffness and swelling than might be expected after open repair. We present the first combined arthroscopic-assisted anteromedial facet coronoid fracture fixation and lateral ulna collateral ligament repair in a varus posteromedial rotatory injury of the elbow.

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