scholarly journals Therapeutic interventions for acute complete ruptures of the ulnar collateral ligament of the thumb: a systematic review

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 714 ◽  
Author(s):  
Mark Mikhail ◽  
Justin C. R. Wormald ◽  
Neal Thurley ◽  
Nicholas Riley ◽  
Benjamin J. F. Dean
Keyword(s):  
Steel Wire ◽  
Surgical Techniques ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Therapeutic Interventions ◽  
Collateral Ligament ◽  
Pull Out ◽  
Complete Rupture ◽  
English Language Journal ◽  
Pull Out Suture

Background: The aim of this study was to evaluate the effectiveness of interventions for acute complete rupture of the ulnar collateral ligament (UCL) of the thumb in adults. Methods: The following databases were searched: MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO, from database inception to 31st January 2018. Inclusion criteria were: (i) randomised controlled clinical trials (RCTs) or study of intervention with a comparator; (ii) participants with diagnosis of acute complete rupture of the UCL of the thumb; (iii) participants aged 18 years of age or older at enrolment; and (iv) published in a peer-reviewed English-language journal. Results: In total, six studies were identified for inclusion after screening. All studies had a high risk of bias. Three studies were retrospective comparative case series which compared two different surgical techniques (bone anchor versus pull out suture, suture versus pull out suture, suture versus steel wire). Of these studies, three were RCTs, two of which compared different rehabilitation regimes in patients managed surgically (plaster versus early mobilization, new spica versus standard spica). The remaining RCT compared two different rehabilitation regimes in a mixed group of surgically/non-surgically treated patients. The RCT comparing a standard spica with a new spica demonstrated a statistically significant improvement in outcomes with the new spica at all time points (range of motion, Dreiser index and VAS); this was also the only study to provide sufficient outcome data for further analysis. Conclusion: There is no prospective evidence comparing surgery to non-operative treatment for acute complete ruptures of the ulnar collateral ligament of the thumb. There is weak evidence to suggest that early mobilisation may be beneficial following surgical repair. Further research is necessary to better define which patients benefit from which specific interventions.

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.

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

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876932 ◽  
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.

Clinical Testing of Ulnar Collateral Ligament Injuries of the Thumb

2009 ◽  
Vol 34 (3) ◽  
pp. 363-366 ◽  
Author(s):  
A. K. MALIK ◽  
T. MORRIS ◽  
D. CHOU ◽  
E. SORENE ◽  
E. TAYLOR
Keyword(s):  
Ulnar Collateral Ligament ◽  
Clinical Testing ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
End Point ◽  
Complete Rupture ◽  
Normal Individuals ◽  
Stress Examination

The diagnosis of complete tears of the ulnar collateral ligament of the thumb metacarpophalangeal (MP) joint depends on demonstration of excessive laxity of the ligament, but there is controversy on whether laxity greater than a certain cut-off value or laxity greater than the opposite thumb is the criterion for diagnosis. We examined 200 thumbs of 100 normal individuals in extension and in 30° of flexion. In 34% of subjects there was a difference of 10° or more between right and left thumbs in extension, and 12% had a difference of at least 15°. In flexion, 22% of thumbs differed by 10° or more and 3% by 15° or more. Comparison with the uninjured contralateral thumb is unreliable in many individuals. We recommend the lack of a definite end point on stress examination as indicating complete rupture of the ulnar collateral ligament.

Ulnar Collateral Ligament Repair of the Metacarpo-Phalangeal Joint of the Thumb: A Study Comparing Two Methods of Repair

1992 ◽  
Vol 17 (2) ◽  
pp. 160-163 ◽  
Author(s):  
J. P. SAETTA ◽  
I. C. PHAIR ◽  
D. N. QUINTON
Keyword(s):  
Physical Examination ◽  
Avulsion Fracture ◽  
Steel Wire ◽  
Ulnar Collateral Ligament ◽  
Functional Testing ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Mattress Suture ◽  
Clinical Advantage ◽  
Horizontal Mattress Suture

25 patients were assessed following repair of an acutely ruptured ulnar collateral ligament of the thumb metacarpo-phalangeal joint. The patients were divided into two groups, repaired by either a horizontal mattress suture using 4/0 polybutylate (nine patients), or a pre-fashioned steel wire (16 patients). Assessment included a physical examination and functional testing at a mean of 12.9 months (range 4–36 months) after the operation. Both techniques were equally effective, and the use of the more expensive steel wire, while technically satisfying and easy to perform, offers no clinical advantage over simple suture. This pre-fashioned steel wire is, however, recommended in those cases with an avulsion fracture or where distal avulsion of the ligament is associated, since the technique allows easy secure reduction.

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.

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

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.

scholarly journals Comparison of Ulnar Collateral Ligament Reconstruction Techniques in the Elbow of Sports Players

2020 ◽  
Vol 23 (1) ◽  
pp. 41-47
Author(s):  
Jun-Gyu Moon ◽  
Hee-Dong Lee
Keyword(s):  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Surgical Techniques ◽  
Ulnar Collateral Ligament ◽  
Review Article ◽  
Return To Sports ◽  
Collateral Ligament ◽  
Technical Issues ◽  
Graft Selection ◽  
Ulnar Collateral Ligament Reconstruction

Ulnar collateral ligament injuries have been increasingly common in overhead throwing athletes. Ulnar collateral ligament reconstruction is the current gold standard for managing ulnar collateral ligament insufficiency, and numerous reconstruction techniques have been described. Although good clinical outcomes have been reported regarding return to sports, there are still several technical issues including exposure, graft selection and fixation, and ulnar nerve management. This review article summarizes a variety of surgical techniques of ulnar collateral ligament reconstructions and compares clinical outcomes and biomechanics.

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