Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Management of Ulnar Collateral Ligament Injuries in Overhead Athletes

  • Jang, Suk-Hwan (Department of Orthopedic Surgery, Sports Medicine Research Institute, Inje University Seoul Paik Hospital)
  • Received : 2019.08.16
  • Accepted : 2019.10.22
  • Published : 2019.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Ulnar collateral ligament injuries of the elbow are frequent among overhead athletes. The incidence of ulnar collateral ligament reconstructions (UCLRs) in high-level players has increased dramatically over the past decade, but the optimal technique of UCLR is controversial. Surgeons need to manage the patients' expectations appropriately when considering the mode of treatment. This article reviews current studies on the management of ulnar collateral ligament injuries, particularly in overhead athletes.

Keywords

References

  1. Erickson BJ, Gupta AK, Harris JD, et al. Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers. Am J Sports Med. 2014;42(3):536-43. doi: 10.1177/0363546513510890.
  2. Hodgins JL, Vitale M, Arons RR, Ahmad CS. Epidemiology of medial ulnar collateral ligament reconstruction: a 10-year study in New York state. Am J Sports Med. 2016;44(3):729-34. doi: 10.1177/0363546515622407.
  3. Erickson BJ, Harris JD, Tetreault M, Bush-Joseph C, Cohen M, Romeo AA. Is Tommy John surgery performed more frequently in major league baseball pitchers from warm weather areas? Orthop J Sports Med. 2014;2(10):2325967114553916. doi:10.1177/2325967114553916.
  4. Wilk KE, Macrina LC, Fleisig GS, et al. Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers: a prospective study. Am J Sports Med. 2015;43(10):2379-85. doi: 10.1177/0363546515594380.
  5. Chalmers PN, Erickson BJ, Ball B, Romeo AA, Verma NN. Fastball pitch velocity helps predict ulnar collateral ligament reconstruction in major league baseball pitchers. Am J Sports Med. 2016;44(8):2130-5. doi: 10.1177/0363546516634305.
  6. Erickson BJ, Sgori T, Chalmers PN, et al. The impact of fatigue on baseball pitching mechanics in adolescent male pitchers. Arthroscopy. 2016;32(5):762-71. doi: 10.1016/j.arthro.2015.11.051.
  7. Byram IR, Bushnell BD, Dugger K, Charron K, Harrell FE Jr, Noonan TJ. Preseason shoulder strength measurements in professional baseball pitchers: identifying players at risk for injury. Am J Sports Med. 2010;38(7):1375-82. doi: 10.1177/0363546509360404.
  8. Makhni EC, Morrow ZS, Luchetti TJ, et al. Arm pain in youth baseball players: a survey of healthy players. Am J Sports Med. 2015;43(1):41-6. doi: 10.1177/0363546514555506.
  9. Erickson BJ, Romeo AA. The ulnar collateral ligament injury:evaluation and treatment. J Bone Joint Surg Am. 2017;99(1):76-86. doi: 10.2106/JBJS.16.01277.
  10. Redler LH, Watling JP, Ahmad CS. Physical examination of the throwing athlete's elbow. Am J Orthop (Belle Mead NJ). 2015;44(1):13-8.
  11. O'Driscoll SW, Lawton RL, Smith AM. The "moving valgus stress test" for medial collateral ligament tears of the elbow. Am J Sports Med. 2005;33(2):231-9. doi: 10.1177/0363546504267804.
  12. Ciccotti MG, Atanda A Jr, Nazarian LN, Dodson CC, Holmes L, Cohen SB. Stress sonography of the ulnar collateral ligament of the elbow in professional baseball pitchers: a 10-year study. Am J Sports Med. 2014;42(3):544-51. doi: 10.1177/0363546513516592.
  13. Kim NR, Moon SG, Park JY, Choi JW, Oh KS. Stress ultrasound in baseball players with ulnar collateral ligament injuries: additional value for predicting rehabilitation outcome. J Shoulder Elbow Surg. 2017;26(5):815-23. doi: 10.1016/j.jse.2016.12.075.
  14. Magee T. MR versus MR arthrography in detection of supraspinatus tendon tears in patients without previous shoulder surgery. Skeletal Radiol. 2014;43(1):43-8. doi: 10.1007/s00256-013-1745-x.
  15. Dines JS, ElAttrache NS, Conway JE, Smith W, Ahmad CS. Clinical outcomes of the DANE TJ technique to treat ulnar collateral ligament insufficiency of the elbow. Am J Sports Med. 2007;35(12):2039-44. doi: 10.1177/0363546507305802.
  16. Park JY, Chung SW, Lee JG, et al. The effect of humeral tunnel locations on radiographic tunnel changes in baseball players following medial ulnar collateral ligament reconstruction: comparison of anatomic and nonanatomic locations. J Shoulder Elbow Surg. 2018;27(6):1037-43. doi: 10.1016/j.jse.2017.11.026.
  17. Rettig AC, Sherrill C, Snead DS, Mendler JC, Mieling P. Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med. 2001;29(1):15-7. doi:10.1177/03635465010290010601.
  18. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Returnto-play outcomes in professional baseball players after medial ulnar collateral ligament injuries: comparison of operative versus nonoperative treatment based on magnetic resonance imaging findings. Am J Sports Med. 2016;44(3):723-8. doi:10.1177/0363546515621756.
  19. Jung HS, Park MJ. Medial instability of the elbow. Arch Hand Microsurg. 2018;23(2):78-86. doi: 10.12790/ahm.2018.23.2.78.
  20. Erickson BJ, Bach BR Jr, Cohen MS, et al. Ulnar collateral ligament reconstruction: the rush experience. Orthop J Sports Med. 2016;4(1):2325967115626876. doi: 10.1177/2325967115626876.
  21. Dines JS, Williams PN, ElAttrache N, et al. Platelet-rich plasma can be used to successfully treat elbow ulnar collateral ligament insufficiency in high-level throwers. Am J Orthop (Belle Mead NJ). 2016;45(5):296-300.
  22. Frangiamore SJ, Lynch TS, Vaughn MD, et al. Magnetic resonance imaging predictors of failure in the nonoperative management of ulnar collateral ligament injuries in professional baseball pitchers. Am J Sports Med. 2017;45(8):1783-9. doi:10.1177/0363546517699832.
  23. Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74(1):67-83. https://doi.org/10.2106/00004623-199274010-00009
  24. Erickson BJ, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Treatment of ulnar collateral ligament tears of the elbow: is repair a viable option? Orthop J Sports Med. 2017;5(1):2325967116682211. doi: 10.1177/2325967116682211.
  25. Dugas JR, Walters BL, Beason DP, Fleisig GS, Chronister JE. Biomechanical comparison of ulnar collateral ligament repair with internal bracing versus modified Jobe reconstruction. Am J Sports Med. 2016;44(3):735-41. doi: 10.1177/0363546515620390.
  26. Dugas JR, Looze CA, Capogna B, et al. Ulnar collateral ligament repair with collagen-dipped FiberTape augmentation in overhead-throwing athletes. Am J Sports Med. 2019;47(5):1096-102. doi: 10.1177/0363546519833684.
  27. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am. 1986;68(8):1158-63. https://doi.org/10.2106/00004623-198668080-00004
  28. Park JY, Oh KS, Bahng SC, Chung SW, Choi JH. Does well maintained graft provide consistent return to play after medial ulnar collateral ligament reconstruction of the elbow joint in elite baseball players? Clin Orthop Surg. 2014;6(2):190-5. doi:10.4055/cios.2014.6.2.190.
  29. Rohrbough JT, Altchek DW, Hyman J, Williams RJ 3rd, Botts JD. Medial collateral ligament reconstruction of the elbow using the docking technique. Am J Sports Med. 2002;30(4):541-8. doi: 10.1177/03635465020300041401.
  30. Cain EL Jr, Andrews JR, Dugas JR, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year followup. Am J Sports Med. 2010;38(12):2426-34. doi: 10.1177/0363546510378100.
  31. Erickson BJ, Chalmers PN, Bush-Joseph CA, Verma NN, Romeo AA. Ulnar collateral ligament reconstruction of the elbow: a systematic review of the literature. Orthop J Sports Med. 2015;3(12):2325967115618914. doi: 10.1177/2325967115618914.
  32. Saltzman BM, Erickson BJ, Frank JM, et al. Biomechanical testing of the reconstructed ulnar collateral ligament: a systematic review of the literature. Musculoskelet Surg. 2016;100(3):157-63. doi: 10.1007/s12306-016-0426-z.
  33. Erickson BJ, Cvetanovich GL, Frank RM, et al. Do clinical results and return-to-sport rates after ulnar collateral ligament reconstruction differ based on graft choice and surgical technique? Orthop J Sports Med. 2016;4(11):2325967116670142. doi: 10.1177/2325967116670142.
  34. Keller RA, Mehran N, Khalil LS, Ahmad CS, ElAttrache N. Relative individual workload changes may be a risk factor for rerupture of ulnar collateral ligament reconstruction. J Shoulder Elbow Surg. 2017;26(3):369-75. doi: 10.1016/j.jse.2016.11.045.
  35. Seto JL, Brewster CE, Randall CC, Jobe FW. Rehabilitation following ulnar collateral ligament reconstruction of athletes. J Orthop Sports Phys Ther. 1991;14(3):100-5. doi: 10.2519/jospt.1991.14.3.100.
  36. Ahmad CS, Grantham WJ, Greiwe RM. Public perceptions of Tommy John surgery. Phys Sportsmed. 2012;40(2):64-72. doi:10.3810/psm.2012.05.1966.
  37. Jiang JJ, Leland JM. Analysis of pitching velocity in major league baseball players before and after ulnar collateral ligament reconstruction. Am J Sports Med. 2014;42(4):880-5. doi:10.1177/0363546513519072.
  38. Osbahr DC, Swaminathan SS, Allen AA, Dines JS, Coleman SH, Altchek DW. Combined flexor-pronator mass and ulnar collateral ligament injuries in the elbows of older baseball players. Am J Sports Med. 2010;38(4):733-9. doi:10.1177/0363546509351558.
  39. Osbahr DC, Dines JS, Rosenbaum AJ, Nguyen JT, Altchek DW. Does posteromedial chondromalacia reduce rate of return to play after ulnar collateral ligament reconstruction? Clin Orthop Relat Res. 2012;470(6):1558-64. doi: 10.1007/s11999-011-2132-3.
  40. Dugas JR, Bilotta J, Watts CD, et al. Ulnar collateral ligament reconstruction with gracilis tendon in athletes with intraligamentous bony excision: technique and results. Am J Sports Med. 2012;40(7):1578-82. doi: 10.1177/0363546512446927.
  41. Wilson AT, Pidgeon TS, Morrell NT, DaSilva MF. Trends in revision elbow ulnar collateral ligament reconstruction in professional baseball pitchers. J Hand Surg Am. 2015;40(11):2249-54. doi: 10.1016/j.jhsa.2015.07.024.
  42. Marshall NE, Keller RA, Lynch JR, Bey MJ, Moutzouros V. Pitching performance and longevity after revision ulnar collateral ligament reconstruction in Major League Baseball pitchers. Am J Sports Med. 2015;43(5):1051-6. doi: 10.1177/0363546515579636.