Outcomes after Elbow Ulnar Collateral Ligament Reconstruction with the Docking Plus Technique in 162 Athletes (129)

Objectives: This retrospective case series examined 162 athletes who underwent ulnar collateral ligament (UCL) reconstruction (UCLR) from 2015-2018. All cases were by a single surgeon at a high volume center using the Docking Plus Technique. We previously reported outcomes in 324 athletes from 2005-2014 with 88% of patients reporting a Conway score of good or excellent. The purpose of this study was to determine if patients undergoing UCLR with the docking plus technique are able to return to sport and to better characterize the athletes needing this procedure. Our hypothesis was that our cohort would largely be able to return to their previous level of play and be mostly college level pitchers. Methods: Patients who underwent UCLR at our institution from 2015-2018 were identified and surveyed. We were able to reach a total of 162 patients by telephone for a survey. They were surveyed for subjective and objective outcomes and for background demographic information including information about their athletic careers before and after UCLR. Results: Of our 162 respondents, 150 (93%) returned to the same level of play or higher (excellent on Conway classification). 9 did not return to competitive play (6%) while 3 returned to a lower level of play. 5 of those who did not return to competitive play had their surgery senior year of college. Most athletes were in college at the time of surgery (61%), followed by high school (32%). 2 athletes were in middle school, the rest were playing professionally. Baseball pitchers compromised the majority of our respondents (75%). Catchers were 9% of respondents and infielders/outfielders were 3% each. Other athletes participated in cheerleading, lacrosse, track, volleyball, gymnastics, wrestling, and football, though these were far less common. The mean and median ages of survey respondents was 19 (12-31). 61% described an acute “pop” leading to their elbow pain while 39% endorses no acute event but chronic elbow pain leading to presentation. Of the 61% presenting with an acute rupture, 40% endorsed an “acute on chronic,” presentation. 58% of baseball players played more than just baseball in high school while 41% had specialized in just baseball. The average return to competitive play was 12 months, with a range of 4-24. The range for pitchers was 9-24 with an average of around. Conclusions: Overall, our results mirror those of previous studies. 93% of our patients returned to the same level of competition or higher after undergoing UCLR with the docking plus technique. Most of those who did not return were college seniors who graduated. Our typical patient was a college baseball pitcher around 19 years old. Return to play with our set rehab protocol was around 1 year, though faster for non-pitchers. The docking plus technique provides reliable treatment for chronic or acute UCL tears in athletes.

Download Full-text

Outcomes after Elbow Ulnar Collateral Ligament Reconstruction with the Docking Plus Technique in 163 Athletes

10.21203/rs.3.rs-119023/v1 ◽

2020 ◽

Author(s):

Marc Lubitz ◽

Benjamin Donohue ◽

Vadim Molla ◽

Timothy Kremchek

Keyword(s):

Case Series ◽

Return To Sport ◽

Ulnar Collateral Ligament ◽

High Volume ◽

Return To Play ◽

College Level ◽

Collateral Ligament ◽

Retrospective Case ◽

Before And After ◽

High Level

Abstract Background: This retrospective case series examined 163 athletes who underwent ulnar collateral ligament (UCL) reconstruction (UCLR) from 2015-2018. All cases were by a single surgeon at a high volume center using the Docking Plus Technique. We previously reported outcomes in 324 athletes from 2005-2014 with 88% of patients reporting a Conway score of good or excellent. Purpose/Hypothesis: The purpose of this study was to determine if patients undergoing UCLR with the docking plus technique are able to return to sport and to better characterize the athletes needing this procedure. Our hypothesis was that our cohort would largely be able to return to their previous level of play and be mostly college level pitchers. Methods: Patients who underwent UCLR at our institution from 2015-2018 were identified and surveyed. We were able to reach a total of 163 patients and they were asked for background demographic information and information about their athletic careers before and after UCLR. Results: Our results were largely similar to our previously study with 94.5% of athletes obtaining Conway scores of Good or Excellent. 95% of athletes were male, 91% played baseball, and 83% of baseball players were pitchers. 59% of athletes were in college at the time of their surgery. For 8 athletes, this was a revision procedure, 7 of the revisions were for pitchers. 5 of the 7 pitchers were able to get back to the same level or higher of competition. 98.8% of patients surveyed said they were “satisfied with the outcome of the surgery.” Conclusions: The Docking Plus Technique performed by a single surgeon at a private practice setting leads to reproducible return to play and patient satisfaction. The prototypical patient undergoing UCLR is a high level male baseball pitcher. UCL outcomes data would benefit from more prospective studies and the creation of a nationwide UCLR database to draw conclusions about technique, graft type, risk factors, and many more relevant variables.

Download Full-text

Outcomes and Return to Sport After Ulnar Collateral Ligament Reconstruction in Adolescent Baseball Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118769328 ◽

2018 ◽

Vol 6 (4) ◽

pp. 232596711876932 ◽

Cited By ~ 7

Author(s):

Michael Saper ◽

Joseph Shung ◽

Stephanie Pearce ◽

Viviana Bompadre ◽

James R. Andrews

Keyword(s):

Case Series ◽

Return To Sport ◽

Ulnar Collateral Ligament ◽

Collateral Ligament ◽

Baseball Players ◽

Duration Of Symptoms ◽

Excellent Outcome ◽

Patient Reported ◽

The Mean

Background: The number of ulnar collateral ligament (UCL) reconstructions in adolescent athletes has increased over the past 2 decades. Clinical results in this population have not been well studied. Purpose/Hypothesis: The purpose of this study was to evaluate the outcomes and return to sport after UCL reconstruction in a large group of adolescent baseball players. We hypothesized that excellent clinical outcomes and high rates of return to sport would be observed in this population at a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 140 adolescent (aged ≤19 years) baseball players who underwent UCL reconstruction with the American Sports Medicine Institute (ASMI) technique by a single surgeon. Medical records were reviewed for patient demographics, injury characteristics, operative details, and surgical complications. Patient-reported outcomes were assessed using the Conway scale, the Andrews-Timmerman (A-T) score, the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, and a 0- to 100-point subjective scale for elbow function and satisfaction. Return to sporting activity was assessed using a custom-designed questionnaire. Results: The mean age at the time of surgery was 18.0 years (range, 13-19 years), and the mean follow-up was 57.9 months (range, 32.4-115.4 months). Over half (60%) of patients were high school athletes. The mean duration of symptoms before surgery was 6.9 months (range, 0.5-60.0 months). Partial tears were identified in 57.9% of patients, and 41.3% of patients had preoperative ulnar nerve symptoms. Graft type included the ipsilateral palmaris in 77.1% of patients. Concomitant procedures were performed in 25% of patients. Outcomes on the Conway scale were “excellent” in 86.4% of patients. The mean A-T and KJOC scores were 97.3 ± 6.1 and 85.2 ± 14.6, respectively. Mean patient satisfaction was 94.4. Overall, 97.8% of patients reported returning to sport at a mean of 11.6 months (range, 5-24 months), and 89.9% of patients returned to sport at the same level of competition or higher. A total of 11.6% of patients went on to play professional baseball. Conclusion: UCL reconstruction with the ASMI technique is an effective surgical option in adolescents, with excellent outcome scores. At a minimum of 2-year follow-up, nearly 90% of patients returned to their preinjury level of sport.

Download Full-text

Early Return to Play With Thumb Spica Gauntlet Casting for Ulnar Collateral Ligament Injuries Complicated by Adjacent Joint Dislocations in Collegiate Football Linemen

Hand ◽

10.1177/1558944718788644 ◽

2018 ◽

Vol 15 (1) ◽

pp. 92-96 ◽

Cited By ~ 1

Author(s):

Derek T. Bernstein ◽

Patrick C. McCulloch ◽

Leland A. Winston ◽

Shari R. Liberman

Keyword(s):

Surgical Repair ◽

Return To Sport ◽

Ulnar Collateral Ligament ◽

Return To Play ◽

Additional Stress ◽

Collateral Ligament ◽

Spica Casting ◽

Joint Dislocations ◽

The Mean

Background: Treatment of thumb ulnar collateral ligament (UCL) ruptures in elite athletes aims to restore thumb stability while minimizing lost playing time. Thus, surgical repair with early protected return to play in a thumb spica cast has been advocated. The purpose of this study was to document adjacent joint dislocations after primary surgical repair sustained during protected return to play with thumb spica casting in elite-level football players. Methods: Three Division I collegiate starting linemen sustaining adjacent joint dislocations in thumb spica casts following acute surgical repair of ipsilateral thumb UCL ruptures were retrospectively reviewed. Demographic data were recorded as well as the timeline for injury, treatment, and subsequent return to sport. Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were obtained at final follow-up. Results: The mean time from thumb UCL injury to surgical repair was 8.7 days, and the mean return to sport was 13.3 days from surgery. There were 4 simple dislocations including 3 proximal interphalangeal (PIP) joints and 1 elbow. Each PIP dislocation was close reduced and treated with buddy straps with immediate return to play. The elbow dislocation was close reduced and splinted with return to play 22 days after injury. The mean QuickDASH score was 2.3 at 12 month follow-up. Conclusions: This report highlights that while thumb spica casting protects the surgically repaired thumb UCL and allows for earlier return to play, it risks placing additional stress upon adjacent joints and therefore adjacent injury. Appropriate counseling of the risks and benefits of this treatment strategy is essential.

Download Full-text

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211014230 ◽

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.

Download Full-text

Outcomes After Ulnar Collateral Ligament Revision Reconstruction in Baseball Players

The American Journal of Sports Medicine ◽

10.1177/0363546520951529 ◽

2020 ◽

Vol 48 (13) ◽

pp. 3359-3364

Author(s):

James R. Andrews ◽

Vikram Venkateswaran ◽

Kevin D. Christensen ◽

Hillary A. Plummer ◽

Karen M. Hart ◽

...

Keyword(s):

Clinical Decision Making ◽

Excellent Result ◽

Case Series ◽

Ulnar Collateral Ligament ◽

Return To Play ◽

Collateral Ligament ◽

Baseball Players ◽

Overhead Athletes ◽

Patient Reported ◽

Revision Reconstruction

Background: There is a lack of evidence regarding the success of ulnar collateral ligament (UCL) revision reconstruction. Understanding outcomes after UCL revision reconstruction is important in clinical decision making for overhead athletes. Purpose: To evaluate return to play and patient-reported outcomes after UCL revision reconstruction. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent UCL revision reconstruction, attributed to retear of the ligament or pain, between June 2004 and July 2016 at 2 surgical centers were identified. Charts were reviewed for age, sex, date of primary and revision reconstruction, sport played, level of play, graft type, and complications. Patients were contacted by telephone to determine time to return to play, current level of participation, Conway score, Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, and satisfaction. Results: Of the 65 consecutive baseball players who underwent revision UCL reconstruction, 40 (62%) were contacted at a minimum 22 months after surgery. Of these, 38 (95%) were pitchers and 2 (5%) were position players. Time to return to throwing was 6.2 ± 2.3 months (mean ± SD), and the KJOC score was 74.2 ± 20.7. Based on the Conway score, 50% (20/40) had an excellent result, indicating a return to the previous competition level for at least 1 year, and 30% (12/40) had a good result, indicating a return to a lower level for at least 1 year. For those who were able to return to competition, it took 12.7 ± 3.6 months. In pitchers, 47% (18/38) returned to their previous competition levels for at least 1 year, with a KJOC score of 73.7 ± 21.1. Pitchers were able to return to throwing at 6.3 ± 2.3 months and competition at 12.8 ± 3.7 months. Conclusion: Only half of baseball players undergoing UCL revision reconstruction were able to return to their previous levels of competition. Outcomes for revision reconstructions are not as promising as primary procedures. Baseball players should be cautioned that they may not return to their previous levels of play after a revision reconstruction.

Download Full-text

Medial Elbow Pain During the Return-to-Throwing Period After Ulnar Collateral Ligament Reconstruction in Pitchers

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118808782 ◽

2018 ◽

Vol 6 (11) ◽

pp. 232596711880878

Author(s):

Robert A. Keller ◽

Nathan E. Marshall ◽

Orr Limpisvasti ◽

Anthony F. DeGiacomo ◽

Michael Banffy ◽

...

Keyword(s):

Ligament Reconstruction ◽

Return To Sport ◽

Ulnar Collateral Ligament ◽

Single Institution ◽

Collateral Ligament ◽

Level Of Evidence ◽

Elbow Pain ◽

Mean Time ◽

Control Study ◽

Ulnar Collateral Ligament Reconstruction

Background: Ulnar collateral ligament reconstruction (UCLR) is common in the sport of baseball, particularly among pitchers. Postoperative return-to-sport protocols have many players beginning to throw at 4 to 5 months and returning to full competition between 12 and 16 months after surgery. Medial elbow pain during the return-to-throwing period often occurs and can be difficult to manage. Purpose: To evaluate the incidence of medial elbow pain and associations with outcomes and revision surgery during the return-to-throwing period after UCLR. Study Design: Case-control study; Level of evidence, 3. Methods: Between the years of 2002 and 2014, all pitchers who underwent UCLR at a single institution were identified. Charts were reviewed for incidence of medial elbow pain during return to throwing, return to sport, and subsequent operative interventions, including revision ulnar collateral ligament surgery. Results: Of a total of 616 pitchers who underwent UCLR during the study period, 317 were included in this study. Medial elbow pain was experienced by 45.1% (143 of 317), with a mean time of complaint of 9.75 months after surgery. The groups with and without pain did not differ statistically with regard to age (pain, 20.6 years; no pain, 20.9 years) or level of competition. Of those who experienced medial elbow pain, 10.5% did not return to sport; 5.6% underwent revision UCLR; and 19.6% underwent other operative procedures at the elbow. Among those who did not experience medial elbow pain when returning to throw, 8.7% did not return to sport, with only 1.7% undergoing revision UCLR and 6.9% undergoing other operative elbow procedures. Conclusion: Of the pitchers evaluated in the study, approximately half reported pain during the return-to-throwing phase after UCLR. Those who experienced medial elbow pain had a higher rate of subsequent surgical intervention.

Download Full-text

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

The American Journal of Sports Medicine ◽

10.1177/0363546519833684 ◽

2019 ◽

Vol 47 (5) ◽

pp. 1096-1102 ◽

Cited By ~ 15

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.

Download Full-text

Outcomes following surgical management of inguinal-related groin pain in athletes: a case series

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz068 ◽

2020 ◽

Vol 7 (1) ◽

pp. 103-108

Author(s):

Michael Gerhardt ◽

Josh Christiansen ◽

Benjamin Sherman ◽

Alejandro Miranda ◽

William Hutchinson ◽

...

Keyword(s):

Groin Pain ◽

Surgical Intervention ◽

Case Series ◽

Return To Sport ◽

Scar Tissue ◽

Nerve Entrapment ◽

Return To Play ◽

Retrospective Case ◽

Operative Findings

Abstract To determine the outcomes of a limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement of adhesions based on intraoperative findings. Retrospective case series. Outpatient orthopedic/general surgery clinic. Fifty-one athletes treated surgically for inguinal-related groin pain from 2009 to 2015. Limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement based on intra-operative findings. Ability to return to sport at the same level, time to return to play. Fifty-one athletes were included in the study with an average follow-up of 4.42 years (range 2.02–7.01). The average age was 24.2 years (range 16–49) and consisted of 94.0% males and 6.0% females. Nerve entrapment was demonstrated in 96.2% of cases with involvement of the ilioinguinal in 92.5%, the iliohypogastric in 30.8% and the genitofemoral in 13.2%. Attenuation of the posterior inguinal wall was present and repaired in 79.3% of cases. Scar tissue was present around the adductor origin and required debridement in 56.7% of cases. Forty-nine (96.1%) athletes returned to sport at the same level of play at an average of 5.9 weeks. Two athletes required a revision surgery. High rates of return to sport were achieved after surgery for inguinal-related groin pain that addresses the varying pathology and associated nerve entrapment.

Download Full-text

Repair of the ulnar collateral ligament of the elbow with internal brace augmentation: a 5-year follow-up

BMJ Case Reports ◽

10.1136/bcr-2018-227113 ◽

2018 ◽

Vol 11 (1) ◽

pp. e227113 ◽

Cited By ~ 1

Author(s):

William T Wilson ◽

Graeme P Hopper ◽

Paul A Byrne ◽

Gordon M MacKay

Keyword(s):

Surgical Techniques ◽

Ulnar Collateral Ligament ◽

American Football ◽

Return To Play ◽

College Level ◽

Collateral Ligament ◽

Elbow Injury ◽

Graft Harvest ◽

Internal Brace ◽

Return To College

The ulnar collateral ligament (UCL) is the primary restraint to valgus angulation at the elbow. Injury to the UCL is increasingly common and can lead to instability, especially in athletes involved in overhead throwing. Conventional treatment is reconstruction using tendon autograft but performance levels are often restricted after long periods of rehabilitation. Modern surgical techniques have led to renewed interest in repair of the ligament, with the aim of restoring native anatomy. This has the benefit of retained proprioception and no graft harvest morbidity. Furthermore, augmentation of the repair with an Internal Brace protects the healing ligament, while allowing early rehabilitation and accelerated return to play. Here we present the first patient treated with this technique who achieved excellent recovery with return to college level American Football after 4 months. Five years later he has good elbow function and plays at the same level.

Download Full-text

The Treatment and Outcomes of Medial Malleolar Stress Fractures

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738114546089 ◽

2014 ◽

Vol 6 (6) ◽

pp. 527-530 ◽

Cited By ~ 9

Author(s):

Val Irion ◽

Timothy L. Miller ◽

Christopher C. Kaeding

Keyword(s):

Stress Fracture ◽

Treatment Options ◽

Case Series ◽

Return To Sport ◽

Stress Fractures ◽

Return To Play ◽

Cochrane Library ◽

Medial Malleolus ◽

Retrospective Case ◽

Level Of Evidence

Context: The medial malleolus is considered a high-risk stress fracture and can be debilitating to the highly active or athletic populations. A range of treatment methods have been described with varying outcomes. Currently, there is no gold standard treatment option with optimal results described. Objective: A systematic search of the literature to determine treatment options and outcomes in medial malleolus stress fractures. Data Sources: OVID/Medline, EMBASE, and the Cochrane Library from 1950 to September 2013. Study Selection: Included studies mentioned treatment and outcomes of medial malleolus stress fractures. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: The searches used combinations of the terms stress fracture, medial malleolus, management, and treatment. Two authors independently reviewed the selected articles and created individual tables, which were later compiled into a master table for final analysis. Results: Six retrospective case series were identified (n = 31 patients). Eighty percent (25/31) of patients were men, with an average age of 24.5 years. Ninety percent (28/31) of patients were at least involved in recreational athletics. All patients were able to return to sport. Complications were seen in both groups ranging from minor stiffness to nonunion requiring open reduction internal fixation. Conclusion: Nonoperative and operative interventions have proven to be successful with regard to healing and return to play for medial malleolar stress fractures in the recreational and competitive athlete. However, early operative intervention can possibly create a higher likelihood of early healing, decrease in symptoms, and return to play.

Download Full-text