Reconstruction Surgeries for Management of Posterolateral Rotatory Instability of The Elbow: A Systematic Review

2021 ◽  
Vol 15 (9) ◽  
pp. 2999-3003
Author(s):  
Ahmed Ali Alrabai ◽  
Abdullah Fahad Raizah
Keyword(s):  
Systematic Review ◽  
Ligament Reconstruction ◽  
Meta Analysis ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
English Only ◽  
Lateral Ulnar Collateral Ligament ◽  
Ulnar Collateral Ligament Reconstruction

We aimed to investigate the indications, techniques, and results of lateral ulnar collateral ligament reconstruction (LUCLR) for posterolateral rotatory instability of the elbow (PLRI) by collecting currently available data. Several databases (PUBMED & EMBASE) were explored for articles published between 2010 and 2020. A search strategy was applied. Altogether, 2,583 studies were recovered for possible inclusion. After adjusting for duplicates, revision of methodology, exclusion of non-full text studies, and those in languages other than English, only four studies remained, which included 51 patients, with more males than females (56.9% and 43.1%, respectively). The patients’ mean age was 35.1 years. Eight patients (15.7%) were managed by the Docking technique in one retrospective study, while 43 patients (84.3%) were managed by the trans-osseous technique. Both trans-osseous and Docking techniques are safe and efficient in the management of PLRI cases. The trans-osseous technique has better functional and postoperative results and lesser complications. Mesh Words: posterolateral rotatory instability of the elbow; lateral ulnar collateral ligament reconstruction surgery; systematic review; meta-analysis

Indications, Outcomes, and Complications of Lateral Ulnar Collateral Ligament Reconstruction of the Elbow for Chronic Posterolateral Rotatory Instability: A Systematic Review

2020 ◽  
pp. 036354652092741
Author(s):  
Shreya Badhrinarayanan ◽  
Ankit Desai ◽  
Jay James Watson ◽  
Callum Hoy Reid White ◽  
Joideep Phadnis
Keyword(s):  
Systematic Review ◽  
Surgical Technique ◽  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Complication Rates ◽  
Collateral Ligament ◽  
Recurrent Instability ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Lateral Ulnar Collateral Ligament

Background: Posterolateral rotatory instability (PLRI) of the elbow can lead to pain, recurrent dislocations, and, in the worst-case scenario, disability. Purpose: To report the indications, outcomes, and complication rates of lateral ulnar collateral ligament (LUCL) reconstruction for chronic PLRI of the elbow. Study Design: Systematic review. Methods: This systematic review was registered with PROSPERO and performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The review entailed 17 studies that included 168 patients with isolated LUCL reconstruction for chronic PLRI. Patients with concurrent medial collateral ligament reconstruction were excluded. The primary outcome measures were patient characteristics, indication for surgery, surgical technique, functional outcomes, and complications. Results: Chronic PLRI commonly occurred after a previous traumatic injury (n = 168). Of these, there were 119 simple instabilities (no fracture) and 33 complex instabilities (associated fracture). In 11 patients, PLRI was iatrogenic. The cause was unknown in 5 patients. Grafts used were autograft (n = 102; 61%), allograft (n = 18; 11%), synthetic graft (n = 15; 9%), and unknown (n = 33; 20%). The most common surgical technique was a docking procedure or a modification of this (n = 145; 86%). Other techniques included suture anchors (n = 18; 11%), nonanatomic (n = 1; 0.6%), and unknown (n = 4; 2%). There were 45 complications reported in 37 patients (22%). The most frequent complication was recurrent instability (21/138; 15%). No other major complications were reported. The rate of recurrent instability was significantly higher in revision reconstructions (6/15 elbows; 40%) compared with primary reconstructions (15/123 elbows; 12.2%) ( P = .005). The mean Mayo Elbow Performance Score and abbreviated Disabilities of the Arm, Shoulder and Hand score were 87.5 (range, 40-100) and 18.8 (range, 0-77), respectively. Of the patients in whom range of motion was measured, 134 of 144 patients (93%) regained a functional range (30L–130L). Conclusion: LUCL reconstruction for chronic PLRI proved a reliable method of reconstruction, save for the moderate rate of recurrent instability, which was highest in revision reconstructions.

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Systematic Review

Hand ◽  
2020 ◽  
pp. 155894472091776
Author(s):  
Austin Fares ◽  
Nicholas Kusnezov ◽  
John C. Dunn
Keyword(s):  
Systematic Review ◽  
Elbow Dislocation ◽  
Ulnar Collateral Ligament ◽  
Tendon Graft ◽  
Common Mechanism ◽  
Collateral Ligament ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Additional Surgery ◽  
Lateral Ulnar Collateral Ligament

Background: Posterolateral rotatory instability (PLRI) is a common form of recurrent elbow instability. The aim of this systematic review is to present the outcomes and complications of lateral ulnar collateral ligament (LUCL) reconstruction surgery for PLRI. Methods: A literature search of LUCL reconstructions was performed, identifying 99 potential papers; 11 of which met inclusion/exclusion criteria, accounting for 148 patients. Papers were included if they reviewed cases of PLRI from 1976 to 2016 with reported outcome measures. Data were pooled and analyzed focusing on patient demographics as well as subjective and objective patient outcomes and complications. Results: The average age of patients was 34 years with a mean follow-up time of 49.8 months. The most common mechanism of injury was a traumatic elbow dislocation (66%), followed by cubitus varus deformity (7%), and unknown mechanisms (7%). Overall, 90% of patients achieved elbow stability and 2.7% experienced a failed reconstruction that necessitated an additional surgery. Furthermore, 93% were satisfied with the outcome of the reconstruction, and 83% reported good to excellent outcomes with 11% reporting moderate to severe persistent pain. Nearly half (45%) of reconstructions were done using a palmaris longus tendon graft, 24% with a triceps tendon graft, and 7% with a synthetic graft. Conclusions: Outcomes following LUCL reconstruction for PLRI are excellent and revision rates are low. LUCL reconstruction is a safe and reliable procedure. Level of Evidence: IV Therapeutic

Ulnar Nerve Complications After Ulnar Collateral Ligament Reconstruction of the Elbow: A Systematic Review

2018 ◽  
Vol 47 (5) ◽  
pp. 1263-1269 ◽  
Author(s):  
Jason B. Clain ◽  
Mark A. Vitale ◽  
Christopher S. Ahmad ◽  
David E. Ruchelsman
Keyword(s):  
Systematic Review ◽  
Ulnar Nerve ◽  
Ligament Reconstruction ◽  
Meta Analysis ◽  
Ulnar Collateral Ligament ◽  
Ulnar Neuropathy ◽  
Collateral Ligament ◽  
Ulnar Nerve Transposition ◽  
Ulnar Collateral Ligament Reconstruction ◽  
Nerve Transposition

Background: While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. Purpose: The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. UCLR case series that contained complications data were included. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Meta-analysis of the pooled data was completed. Results: Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. There were no cases of intraoperative ulnar nerve injury reported. The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). Conclusion: Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature.

No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652110239
Author(s):  
Austin M. Looney ◽  
Nathan P. Fackler ◽  
Mark A. Pianka ◽  
Blake M. Bodendorfer ◽  
Caroline M. Fryar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Procedures ◽  
Ligament Reconstruction ◽  
Meta Analysis ◽  
Ulnar Collateral Ligament ◽  
Likelihood Method ◽  
Complication Rates ◽  
Collateral Ligament ◽  
Significant Difference ◽  
Ulnar Collateral Ligament Reconstruction

Background: The most commonly used techniques for elbow ulnar collateral ligament reconstruction (UCLR) are the docking and modified Jobe figure-of-8 techniques. Previous literature has suggested that UCLR with the docking technique is associated with fewer complications; however, these studies included results from the original classic Jobe technique without controlling for the effects of flexor pronator mass (FPM) detachment and routine submuscular ulnar nerve transposition (UNT). Purpose/Hypothesis: This study sought to compare the rates of complications and subsequent unplanned surgical procedures between the docking and figure-of-8 techniques. We hypothesized that there would be no significant difference in the rates of complications or subsequent unplanned surgical procedures between the techniques when the FPM was preserved and no routine submuscular UNT was performed. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A series of mixed-effects multivariate metaregression models were implemented using the restricted maximum likelihood method. Complications and subsequent unplanned surgical procedures were modeled as Freeman-Tukey transformed incidence rates for variance stabilization, and nerve-specific complications were assessed as the Freeman-Tukey transformed proportion of cases, with back-transformation to estimate summary effects. Results: There were 19 studies eligible for qualitative analysis, consisting of 1788 cases of UCLR (303 docking, 1485 figure-of-8), 18 of which were suitable for quantitative analysis (1769 cases; 291 docking, 1478 figure-of-8). A total of 338 complications were reported (17 for docking, 321 for figure-of-8), the majority of which were nerve related. Additionally, a total of 75 subsequent unplanned surgical procedures were related to the index UCLR procedure. There was no significant difference in the rate of complications ( P = .146) or proportion of cases with nerve-specific complications ( P = .127) between the docking and figure-of-8 techniques when controlling for FPM preservation versus detachment with submuscular UNT. FPM detachment with submuscular UNT was independently associated with a significantly higher proportion of postoperative nerve-related complications ( P = .004). There was also no significant difference in the rates of subsequent unplanned surgical procedures between the docking and figure-of-8 techniques ( P = .961), although FPM detachment with routine submuscular UNT was independently associated with a significantly higher incidence of subsequent unplanned surgical procedures. Conclusion: The results of this study demonstrate no significant difference in the rates of complications or subsequent unplanned surgical procedures between the figure-of-8 and docking techniques for UCLR when controlling for FPM preservation versus detachment with submuscular UNT. With modern muscle-sparing approaches and avoiding submuscular UNT, the modified Jobe technique does not differ significantly from the docking technique in terms of complication rates, proportions of cases with nerve-specific complications, or rates of subsequent unplanned surgical procedures.

Return-to-Competition Criteria After Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652110168
Author(s):  
Matthew J.J. Anderson ◽  
William K. Crockatt ◽  
John D. Mueller ◽  
Justin E. Hellwinkel ◽  
Frank J. Alexander ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ligament Reconstruction ◽  
Meta Analysis ◽  
Ulnar Collateral Ligament ◽  
Minimum Time ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Overhead Throwing ◽  
Return To Competition ◽  
Ulnar Collateral Ligament Reconstruction

Background: Injury to the ulnar collateral ligament of the elbow is common among overhead throwing athletes and can result in significant functional limitations. While surgical reconstruction offers high rates of return to competition, there are no validated or universally accepted guidelines for determining when an athlete can safely resume play. Purpose: To assess the existing scientific literature for return-to-competition criteria utilized after ulnar collateral ligament reconstruction. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: The PubMed database was searched for clinical investigations of ulnar collateral ligament reconstruction in overhead throwing athletes published between January 2000 and June 2020. Only studies that had a minimum follow-up of 1 year and included at least 1 specific return-to-competition criterion were considered. Results: A total of 15 studies were included in the final analysis, encompassing 1156 patients with an average age of 20.7 years (SD, 2.0 years). Baseball players composed 96.3% of patients for whom sport was specified, and 92.4% of baseball players were pitchers. The most common return-to-competition criterion, identified in 87% of studies, was completion of a return-to-throwing program, which started on average 16.7 weeks (range, 12-18 weeks) after surgery. A return-to-mound program was utilized in 53% of studies, starting on average 7.4 months (range, 6-9 months) postoperatively. Minimum time from surgery was used in 73% studies, with players waiting 7 to 12 months (mean, 9.7; SD, 1.4 months) after surgery before return-to-competition consideration. The overall rate of return to competition at the preinjury level or higher was 85.7% (SD, 8.5%) at an average of 12.2 months (SD, 0.6 months). Conclusion: In general, we observed a paucity of literature describing the return-to-competition process after ulnar collateral ligament reconstruction in overhead throwing athletes. Only 3 explicit return-to-competition criteria were identified across all studies: completion of a return-to-throwing program, completion of a return-to-mound program for pitchers, and minimum time from surgery. Increased transparency regarding postoperative rehabilitation protocols and further research are necessary to identify and validate sport-specific return-to-competition criteria, which will ultimately help athletes return to play in a safe and timely fashion after ulnar collateral ligament reconstruction.

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