MRI of the pediatric elbow: Assessment of ligaments, plicae, and cartilage in the clinical setting

2021 ◽  
Keyword(s):  
Sports Medicine ◽  
Ulnar Collateral Ligament ◽  
Poor Quality ◽  
Collateral Ligament ◽  
Young Athletes ◽  
Maximum Extension ◽  
Helpful Tool ◽  
Adolescent Patients ◽  
Elbow Injuries ◽  
And Cartilage

Elbow injuries in young athletes are becoming an increasing concern for orthopedic sports medicine specialists, but imaging is frequently complicated. The purpose of this study was to assess MRI in imaging ligaments, plicae, and cartilage in 65 pediatric and adolescent patients. 9 MRIs (13%) did not allow assessment because of poor quality. In skeletally mature patients, the radial and ulnar collateral ligament were clearly discernable in 94% and 77%, measuring 1.5 ± 0.6 mm and 1.9 ± 0.6, compared to 55% and 59% in the immature patients with a mean thickness of 1.1 ± 0.6 and 1.4 ± 0.6 mm (p<0.05). 12 patients (18%) revealed a cartilaginous pseudodefects, 5 (8%) had a true OCD. 23 (35%) showed a posterolateral plica with a maximum extension of 1.6 ± 1.7 mm. In OCD the plica was significantly larger compared to patients without OCD (p=0.001). While MRI is a helpful tool in assessing elbow injuries, its usefulness is restricted in pediatric and adolescent patients. 1 in 10 MRI studies was too distorted to be read. However, ligaments ad plicae could be well discerned in most patients. At 18% pseudodefects are much less common than in adults (85%).

scholarly journals Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers

2019 ◽  
Vol 47 (5) ◽  
pp. 1103-1110 ◽  
Author(s):  
Timothy B. Griffith ◽  
Christopher S. Ahmad ◽  
Prakash Gorroochurn ◽  
John D’Angelo ◽  
Michael G. Ciccotti ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Professional Baseball ◽  
Reconstruction Technique ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Palmaris Longus ◽  
Elbow Injuries ◽  
Elbow Surgery ◽  
Baseball Pitchers

Background: Professional baseball pitchers are at high risk for tears of the ulnar collateral ligament (UCL) of the elbow, often requiring surgical reconstruction. Despite acceptable published return-to-play outcomes, multiple techniques and graft types have been described. Purpose: This study compares UCL reconstruction (UCLR) outcomes based on tunnel configuration and graft type. Study Design: Cohort study; Level of evidence, 3. Methods: After approval from our institutional review board and Major League Baseball (MLB), 566 professional baseball pitchers who underwent UCLR between 2010 and 2014 were identified and included. The following patient characteristics were analyzed: age, pitching role (starter vs reliever), level of play (MLB vs Minor League Baseball [MiLB]), and throwing side dominance. Surgical factors analyzed included reconstruction technique, graft type, and concomitant procedures. Primary outcome measures consisted of the ability to return to play at any level (RTP), ability to return to the same level of play (RSL), time to return, subsequent elbow injuries, and need for subsequent or revision elbow surgery. The effects of patient and surgical factors on outcomes were analyzed using multivariate linear and logistic regression modeling. Results: The RTP rate was 79.9%, and the RSL rate was 71.2%. Grafts used to reconstruct the UCL included the palmaris longus autograft (n = 361, 63.7%), the gracilis autograft (n = 135, 23.8%), and other grafts (n = 70, 12.5%). Surgical techniques utilized were the docking technique (n = 171, 30.2%), the modified Jobe technique (n = 290, 51.2%), and other techniques (n = 105, 18.6%). There were no significant differences in the time to RTP or RSL based on reconstruction technique or graft type. RTP rates were similar for the docking versus modified Jobe technique (80.1% vs 82.4%, respectively; P = .537) and for the 2 primary graft types (83.1% for palmaris longus vs 80.7% for gracilis; P = .596). The rate of subsequent elbow surgery was 10.5% for the docking technique versus 14.8% for the modified Jobe technique ( P = .203), and the rate of revision UCLR was 2.9% versus 6.2% for the docking versus modified Jobe technique, respectively ( P = .128). Significant trends toward an increasing use of the palmaris longus autograft ( P = .023) and the docking technique ( P = .006) were observed. MLB pitchers were more likely than MiLB pitchers to RTP ( P < .001) and RSL ( P < .001), but they required a longer time to return (mean difference, 35 days; P = .039) and had a higher likelihood of subsequent elbow (odds ratio [OR], 3.58 [95% CI, 2.06-6.23]; P < .001) and forearm injuries (OR, 5.70 [95% CI, 1.99-16.30]; P = .004) but not subsequent elbow surgery. No specific variables correlated with the rates of subsequent elbow surgery or revision UCLR in the multivariate analysis. The use of concomitant ulnar nerve transposition did not affect outcomes. Conclusion: Surgical outcomes in professional baseball players are not significantly influenced by UCLR technique or graft type. There was a high rate (46.3%) of subsequent throwing elbow injuries. MLB pitchers were more likely to RTP and RSL, but they had a higher frequency of subsequent elbow and forearm injuries than MiLB pitchers. Both the docking technique and the palmaris longus autograft are increasing in popularity among surgeons treating professional baseball players.

scholarly journals Is Workload Associated with Ulnar Collateral Ligament Tears in Professional Baseball Players? An Analysis of Days of Rest, Innings Pitched and Batters Faced (126)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0026
Author(s):  
Peter Chalmers ◽  
Kathryn Mcelheny ◽  
John Dangelo ◽  
Kevin Ma ◽  
Dana Rowe ◽  
...  
Keyword(s):  
Major League Baseball ◽  
Tracking System ◽  
Ulnar Collateral Ligament ◽  
Fold Increase ◽  
Professional Baseball ◽  
Control Group ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Elbow Injuries ◽  
Paired Analysis

Objectives: To determine if workload; as measured by number of days rest between outings, innings pitched, batters faced, and being a starting pitcher; associates with risk for sustaining a subsequent UCL tear in professional baseball players. Methods: All professional baseball pitchers who sustained a UCL tear between 2011-2017 were identified using the major league baseball (MLB) Health and Injury Tracking System (HITS). A separate player usage was used to determine workload . We then compared these variables between player-games 2, 6, 12, and >12 weeks prior to a documented UCL tear and player games from a non-UCL tear control group. In a paired analysis, we compared the acute workload (2, 6, 12 weeks) prior to injury and the injured player’s workload >12 weeks prior to injury. Results: There were 2,204 elbow injuries within MLB, 369 of which were unique UCL tears in pitchers. In all time periods, player-games with more days rest, more innings pitched, and more batters faced associated with a subsequent UCL tear. Players who pitched 4 of more innings per outing had a 1.78-fold increase in percent of players with a subsequent UCL tear as compared to players with one inning pitched. Being a starting pitcher carried a relative risk of 1.51 (p<0.001) of subsequent UCL injury. In a paired analysis there were significantly more innings pitched and batters faced in the player-games 2 weeks prior to UCL injury than in the player-games >12 weeks prior to UCL injury (p=0.028 and p=0.017). Conclusions: Being a starting pitcher, pitching more innings per game, and facing more batters per game increased the risk of a UCL tear. An increase in workload in the 2 weeks prior to injury over that player’s baseline also significantly increased the risk for injury.

scholarly journals PEDIATRIC ELBOW COLLATERAL AND ANNULAR LIGAMENT ANATOMY: A CT-BASED CADAVERIC STUDY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0026
Author(s):  
Tyler J. Stavinoha ◽  
Peter C. Cannamela ◽  
Theodore J. Ganley ◽  
Kevin G. Shea
Keyword(s):  
Sports Medicine ◽  
Articular Surface ◽  
Ulnar Collateral Ligament ◽  
Longitudinal Axis ◽  
Joint Surface ◽  
Annular Ligament ◽  
Collateral Ligament ◽  
Reconstructive Procedures ◽  
Lateral Epicondyle ◽  
The Sublime

Background: The medial and lateral ligamentous complexes of the elbow provide static restraint to the elbow and serve as important components of posteromedial and posterolateral rotatory instability. Many collateral ligament and medial epicondylar injuries require surgical repair in those with open physes. Little is known about the anatomy of the pediatric elbow and the relationship between these ligaments and physes. Purpose: To evaluate the anterior bundle of the medial collateral ligament complex, lateral ulnar collateral ligament, annular ligament, and relationships to the joint surfaces and physes. Methods: Two cadaveric elbows from a 3 year-old donor were dissected. Collateral and annular ligaments were isolated and left intact at their osseous attachment. Pins were placed at the origins and insertions and CT scans were used to establish precise anatomic relationships. All dissections and measurements were performed by a single orthopedic surgeon with specialization in pediatric sports medicine. Results: The MUCL origin was a mean 4.10 mm distal and anterior to the medial epicondyle, 10.09 mm from the distal humeral articular surface, and 9.01 mm distal to the medial physis. The distal insertion of the MUCL spanned a mean 3.09 mm and was posterior and medial to the sublime tubercle. In the longitudinal axis, the MUCL insertion footprint spanned the tubercle. The origin was a mean 1.20 mm proximal to the sublime tubercle and the distal extent averaged 2.53 mm distal to the tubercle. The center of the MUCL insertional footprint was 0.38 mm distal to the tubercle. The center of the MUCL was 3.87 mm from the olecranon articular surface. The annular ligament had consistent medial and lateral attachments to the ulna. Distance from the annular ligament attachments to the tip of the coronoid averaged 4.6 mm (4.46 & 4.74 lateral and medial for left; 4.80 & 5.27 lateral and medial for right). The LUCL origin was distal and anterior to the lateral epicondyle. It was 3.43 mm from the lateral epicondyle, 7.51 mm from the articular surface and 0.74 mm distal to the physis. Conclusions: This study is the first to describe anatomy of the elbow collateral and annular ligaments in pediatric cadaveric specimens, through a reliable, CT-based identification method. Knowledge of the precise ligamentous attachments and relationships to the physis and to the joint surface is important for reconstructive procedures. A better understanding of these relationships may assist with surgical planning that preserves adjacent physeal growth regions.

scholarly journals Prevention of Overuse Injuries in Young Baseball Pitchers

2009 ◽  
Vol 1 (6) ◽  
pp. 514-517 ◽  
Author(s):  
Eric D. Parks ◽  
Tracy R. Ray
Keyword(s):  
Ulnar Collateral Ligament ◽  
The United States ◽  
Epidemiological Studies ◽  
Overuse Injuries ◽  
Collateral Ligament ◽  
Arm Pain ◽  
Glenohumeral Internal Rotation Deficit ◽  
Elbow Injuries ◽  
Immature Skeleton ◽  
Central Factors

With millions of athletes participating in baseball in the United States annually, overuse injuries are common occurrences. Epidemiological studies, including surveys of orthopaedic surgeons, coaches, and athletes, indicate that injuries such as those to the ulnar collateral ligament are increasing in incidence. Many risk factors for throwing injuries have been proposed—including the immature skeleton, throwing mechanics, glenohumeral internal rotation deficit, pitch type, velocity, and counts—but little evidence is available to support the majority of these factors. Recent studies have shown that pitch volume and overuse are central factors that lead to shoulder and elbow injuries in the young throwing athlete. Pitching while fatigued and in spite of arm pain has also been implicated.

scholarly journals Evaluation and management of elbow injuries in the adolescent overhead athlete

2021 ◽  
Vol 9 ◽  
pp. 205031212110033
Author(s):  
Austin M Looney ◽  
Paolo D Rigor ◽  
Blake M Bodendorfer
Keyword(s):  
Skeletal Maturity ◽  
Functional Anatomy ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Operative Management ◽  
Collateral Ligament ◽  
Wide Range ◽  
Elbow Injuries ◽  
Overhead Throwing ◽  
Non Operative Management

With an increased interest in youth sports, the burden of overhead throwing elbow injuries accompanying early single-sport focus has steadily risen. During the overhead throwing motion, valgus torque can reach and surpass Newton meters (N m) during the late cocking and early acceleration phases, which exceeds the tensile strength (22.7–33 N m) of the ulnar collateral ligament. While the ulnar collateral ligament serves as the primary valgus stabilizer between and degrees of elbow flexion, other structures about the elbow must contribute to stability during throwing. Depending on an athlete’s stage of skeletal maturity, certain patterns of injury are observed with mechanical failures resulting from increased medial laxity, lateral-sided compression, and posterior extension shearing forces. Together, these injury patterns represent a wide range of conditions that arise from valgus extension overload. The purpose of this article is to review common pathologies observed in the adolescent overhead throwing athlete in the context of functional anatomy, osseous development, and throwing mechanics. Operative and non-operative management and their associated outcomes will be discussed for these injuries.

Primary Repair of Ulnar Collateral Ligament Injuries of the Elbow in Young Athletes

2008 ◽  
Vol 36 (6) ◽  
pp. 1066-1072 ◽  
Author(s):  
Felix H. Savoie ◽  
Scott W. Trenhaile ◽  
John Roberts ◽  
Larry D. Field ◽  
J. Randall Ramsey
Keyword(s):  
Primary Repair ◽  
Ulnar Collateral Ligament ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Young Athletes

scholarly journals Elbow Injuries in National Collegiate Athletic Association Football Players: An Epidemiological Study Spanning 5 Academic Years

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986741
Author(s):  
Zachary K. Christopher ◽  
Justin L. Makovicka ◽  
Kelly L. Scott ◽  
Jeffrey D. Hassebrock ◽  
Karan A. Patel ◽  
...  
Keyword(s):  
National Collegiate Athletic Association ◽  
Ulnar Collateral Ligament ◽  
Common Mechanism ◽  
Football Players ◽  
Participation Restriction ◽  
Collateral Ligament ◽  
Convenience Sample ◽  
Injury Rates ◽  
Elbow Injuries ◽  
Rate Ratios

Background: National Collegiate Athletic Association (NCAA) football players are at a high risk of injuries. Elbow injuries are uncommon, but there are insufficient data specifically on elbow injuries sustained in NCAA football players. Purpose: To define the epidemiology of elbow injuries in NCAA football players during the 2009-2010 to 2013-2014 seasons using data from the NCAA Injury Surveillance Program (NCAA-ISP). Study Design: Descriptive epidemiology study. Methods: Using the NCAA-ISP database, a convenience sample of NCAA football athletes was reviewed to determine the types, rates, and trends in elbow injuries. Several factors were examined, including the diagnosis, injury setting, time lost from sport, surgical necessity, and injury recurrence. Raw injury data were obtained as well as weighted totals from the NCAA-ISP to generate national estimates and adjust for underreporting. Injury rates were calculated by dividing the number of injuries by the total number of athlete-exposures (AEs). The rate ratios of injuries during competition versus practice were compared, as were the rate ratios of preseason, regular-season, and postseason injuries by type. Results: We identified 4874 total elbow injuries from the 2009-2010 to 2013-2014 seasons. The rate of injuries overall was 1.892 per 10,000 AEs. The rate for competition was 9.053 per 10,000 AEs and 1.121 per 10,000 AEs for practice. The rate ratio between competition and practice was 8.08 (95% CI, 6.04-10.80). Injury rates for the preseason, regular season, and postseason were 1.851, 1.936, and 1.406 per 10,000 AEs, respectively. Acute elbow instability was the most common injury type (65.43%). The most common mechanism was a contact injury (86.77%); 96.82% of injuries did not require surgery, and most elbow injuries required less than 24 hours of participation restriction (67.33%). Conclusion: Although elbow injuries in NCAA football players are uncommon, it is important to recognize and treat these injuries appropriately. Dislocations and ulnar collateral ligament injuries caused athletes to miss extended periods of play. Fortunately, a majority of injuries resulted in less than 24 hours of participation restriction. Particular attention should be given to preventing elbow injuries, especially ulnar collateral ligament strains, hyperextension injuries, and acute instability.

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.

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