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

Objectives: Recent studies in the literature have highlighted the progressive increase in the incidence of ulnar collateral ligament (UCL) injuries to the elbow in baseball players of all levels. However, knowledge of the incidence and other epidemiological factors regarding UCL injuries, specifically in college baseball players, is currently lacking. In 2016, we launched a prospective, multi-year study to evaluate the incidence of UCL injuries requiring surgery in National Collegiate Athletic Association (NCAA) Division I baseball programs. Methods: We invited 157 Division I collegiate baseball programs after the 2017 season, and 155 agreed to participate in the study. After the 2018 season, all 297 programs were invited and 294 participated. At the conclusion of the 2017 and 2018 collegiate baseball seasons, the athletic trainer for each program entered anonymous, detailed information on injured players through an electronic survey into a secured database. Results: We obtained a 100% completion rate in the first two years of this ongoing study (155/155 respondents in the first year, 294/294 in the second year). Of the 5,364 collegiate baseball players tracked in Year 1 (2016-2017), 134 underwent surgery for an injured UCL, resulting in a team surgery rate of 0.86 per program. In Year 2 (2017-2018), there were 230 surgeries reported from 10,019 players tracked, resulting in a team surgery rate of 0.78 per program. A majority of schools experienced at least one surgery during both years (56.8% in Year 1, 50.7% in Year 2). Pitchers experience a vast majority of the surgical injuries (85.8% in Year 1, 84.3% in Year 2). Underclassmen made up 65.7% of surgeries in Year 1, which fell slightly to 56.1% in Year 2. Nearly half of the surgeries occurred during an ongoing baseball season in Year 1 (48.5%), but this fell in Year 2 to 41.3%. In both years, a non-significant majority of players were from warm-weather states (65.4% in Year 1, 52.9% in Year 2). Revision surgical rates remained nearly constant with 3.0% revision surgeries in Year 1 compared with 2.6% revisions in Year 2. Interestingly, the percentage of UCL repairs with internal brace augmentation rose from 9.5% in Year 1 to 19.9% of all procedures in Year 2. Conclusion: The incidence of UCL surgeries in NCAA Division I collegiate baseball players represents substantial morbidity to this young athletic population. This multi-year prospective study has been established to assess the incidence of surgical UCL injuries in collegiate baseball. Also, importantly, with multiple years of data we will identify trends in the demographics of players undergoing surgery and in surgical details over time. Awareness of these factors should be considered in injury prevention programs in the future.

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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.

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Repair and Internal Brace Augmentation of the Medial Ulnar Collateral Ligament

Elbow Ulnar Collateral Ligament Injury ◽

10.1007/978-3-030-69567-5_18 ◽

2021 ◽

pp. 183-189

Author(s):

Ryan S. Selley ◽

Elizabeth R. Dennis ◽

Eric N. Windsor ◽

James B. Carr ◽

Joshua S. Dines

Keyword(s):

Ulnar Collateral Ligament ◽

Collateral Ligament ◽

Internal Brace

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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.

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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.

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Biomechanical comparison of docking ulnar collateral ligament reconstruction with and without an internal brace

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2019.04.061 ◽

2019 ◽

Vol 28 (11) ◽

pp. 2247-2252 ◽

Cited By ~ 2

Author(s):

David L. Bernholt ◽

Spencer P. Lake ◽

Ryan M. Castile ◽

Christopher Papangelou ◽

Oliver Hauck ◽

...

Keyword(s):

Ligament Reconstruction ◽

Ulnar Collateral Ligament ◽

Collateral Ligament ◽

Internal Brace ◽

Biomechanical Comparison ◽

Ulnar Collateral Ligament Reconstruction

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

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2020-0069 ◽

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.

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Early Complications of Ulnar Collateral Ligament Repair With Collagen-Coated Suture Tape Augmentation

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211038320 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110383

Author(s):

Marcus A. Rothermich ◽

Glenn S. Fleisig ◽

Hunter E. Lucas ◽

Michael K. Ryan ◽

Benton A. Emblom ◽

...

Keyword(s):

Operating Room ◽

Ulnar Nerve ◽

Major Complication ◽

Ulnar Collateral Ligament ◽

Early Complications ◽

Collateral Ligament ◽

Ulnar Nerve Transposition ◽

Internal Brace ◽

Nerve Transposition

Background: Recent innovative techniques have led to renewed interest in ulnar collateral ligament (UCL) repair. Although early outcome data regarding the clinical outcome of overhead athletes undergoing UCL repair with augmentation have been encouraging, long-term data are still needed to evaluate both the appropriate indications and success rate for this procedure. Purpose: To describe and evaluate the acute complications seen in a large cohort of patients who underwent UCL repair with internal brace augmentation at a single institution. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective chart review of a prospectively collected database, consisting of all patients who underwent UCL repair with internal brace augmentation utilizing a collagen-dipped FiberTape at our institution from August 2013 to January 2020. Patient characteristics, injury setting, side of surgery, and concomitant ulnar nerve transposition procedures were recorded. Early complications of UCL repair (within 6 months of the procedure) were evaluated and characterized as either minor or major, depending on whether the patient required a return to the operating room. Results: Of the 353 patients who underwent UCL repair at our institution with a minimum of 6-month follow-up, 84.7% (299/353) reported no complications, 11.9% (42/353) reported minor complications—including ulnar nerve paresthesia, postoperative medial elbow pain, and postoperative superficial wound complications—and 3.4% (12/353) required a return to the operating room because of a major complication requiring ulnar nerve exploration/debridement, primary ulnar nerve transposition, or heterotopic ossification excision. Conclusion: The low major complication rate identified in this study further validates the efficacy of the UCL repair with the internal bracing augmentation technique. Longer term follow-up data are needed to more adequately assess the outcomes and durability of this procedure.

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