Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Comparison of Ulnar Collateral Ligament Reconstruction Techniques in the Elbow of Sports Players

  • Moon, Jun-Gyu (Department of Orthopedic Surgery, Korea University Guro Hospital) ;
  • Lee, Hee-Dong (Department of Orthopedic Surgery, Korea University Guro Hospital)
  • Received : 2019.08.05
  • Accepted : 2020.02.07
  • Published : 2020.03.01
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Abstract

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.

Keywords

References

  1. Waris W. Elbow injuries of javelin-throwers. Acta Chir Scand 1946;93:563-75.
  2. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am 1986;68:1158-63. https://doi.org/10.2106/00004623-198668080-00004
  3. 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;74:67-83. https://doi.org/10.2106/00004623-199274010-00009
  4. Thompson WH, Jobe FW, Yocum LA, Pink MM. Ulnar collateral ligament reconstruction in athletes: muscle-splitting approach without transposition of the ulnar nerve. J Shoulder Elbow Surg 2001;10:152-7. https://doi.org/10.1067/mse.2001.112881
  5. Andrews JR, Jost PW, Cain EL. The ulnar collateral ligament procedure revisited: the procedure we use. Sports Health 2012;4:438-41. https://doi.org/10.1177/1941738112455318
  6. Andrews JR, Timmerman LA. Outcome of elbow surgery in professional baseball players. Am J Sports Med 1995;23:407-13. https://doi.org/10.1177/036354659502300406
  7. Azar FM, Andrews JR, Wilk KE, Groh D. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med 2000;28:16-23.
  8. Cain EL Jr, Andrews JR, Dugas JR, Wilk KE, McMichael CS, Walter JC 2nd, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up. Am J Sports Med 2010;38:2426-34. https://doi.org/10.1177/0363546510378100
  9. 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;30:541-8. https://doi.org/10.1177/03635465020300041401
  10. Camp CL, Dines JS, Voleti PB, James EW, Altchek DW. Ulnar collateral ligament reconstruction of the elbow: the docking technique. Arthrosc Tech 2016;5:e519-23. https://doi.org/10.1016/j.eats.2016.02.013
  11. Dodson CC, Thomas A, Dines JS, Nho SJ, Williams RJ 3rd, Altchek DW. Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes. Am J Sports Med 2006;34:1926-32. https://doi.org/10.1177/0363546506290988
  12. Paletta GA Jr, Wright RW. The modified docking procedure for elbow ulnar collateral ligament reconstruction: 2-year follow-up in elite throwers. Am J Sports Med 2006;34:1594-8. https://doi.org/10.1177/0363546506289884
  13. Koh JL, Schafer MF, Keuter G, Hsu JE. Ulnar collateral ligament reconstruction in elite throwing athletes. Arthroscopy 2006;22:1187-91. https://doi.org/10.1016/j.arthro.2006.07.024
  14. Bowers AL, Dines JS, Dines DM, Altchek DW. Elbow medial ulnar collateral ligament reconstruction: clinical relevance and the docking technique. J Shoulder Elbow Surg 2010;19:110-7. https://doi.org/10.1016/j.jse.2010.01.005
  15. McGraw MA, Kremchek TE, Hooks TR, Papangelou C. Biomechanical evaluation of the docking plus ulnar collateral ligament reconstruction technique compared with the docking technique. Am J Sports Med 2013;41:313-20. https://doi.org/10.1177/0363546512466375
  16. Donohue BF, Lubitz MG, Kremchek TE. Elbow ulnar collateral ligament reconstruction using the novel docking plus technique in 324 athletes. Sports Med Open 2019;5:3. https://doi.org/10.1186/s40798-018-0174-8
  17. Donohue BF, Lubitz MG, Kremchek TE. Elbow ulnar collateral ligament reconstruction using a 4-strand docking plus technique. Arthrosc Tech 2017;6:e1201-9. https://doi.org/10.1016/j.eats.2017.04.012
  18. Conway JE. The DANE TJ procedure for elbow medial ulnar collateral ligament insufficiency. Tech Shoulder Elb Surg 2006;7:36-43. https://doi.org/10.1097/00132589-200603000-00005
  19. Ahmad CS, Lee TQ, ElAttrache NS. Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation. Am J Sports Med 2003;31:332-7. https://doi.org/10.1177/03635465030310030201
  20. Armstrong AD, Dunning CE, Ferreira LM, Faber KJ, Johnson JA, King GJ. A biomechanical comparison of four reconstruction techniques for the medial collateral ligament-deficient elbow. J Shoulder Elbow Surg 2005;14:207-15. https://doi.org/10.1016/j.jse.2004.06.006
  21. 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;35:2039-44. https://doi.org/10.1177/0363546507305802
  22. Savoie FH 3rd, Trenhaile SW, Roberts J, Field LD, Ramsey JR. Primary repair of ulnar collateral ligament injuries of the elbow in young athletes: a case series of injuries to the proximal and distal ends of the ligament. Am J Sports Med 2008;36:1066-72. https://doi.org/10.1177/0363546508315201
  23. Hechtman KS, Zvijac JE, Wells ME, Botto-van Bemden A. Longterm results of ulnar collateral ligament reconstruction in throwing athletes based on a hybrid technique. Am J Sports Med 2011;39:342-7. https://doi.org/10.1177/0363546510385401
  24. Savoie FH 3rd, Morgan C, Yaste J, Hurt J, Field L. Medial ulnar collateral ligament reconstruction using hamstring allograft in overhead throwing athletes. J Bone Joint Surg Am 2013;95:1062-6. https://doi.org/10.2106/JBJS.L.00213
  25. Hurt JA 3rd, Savoie FH 3rd, O'Brien MJ. Surgical technique: medial ulnar collateral ligament reconstruction using hamstring allograft. JBJS Essent Surg Tech 2013;3:e23. https://doi.org/10.2106/JBJS.ST.M.00032
  26. Myeroff C, Brock JL, Huffman GR. Ulnar collateral ligament reconstruction in athletes using a cortical button suspension technique. J Shoulder Elbow Surg 2018;27:1366-72. https://doi.org/10.1016/j.jse.2018.04.009
  27. Acevedo DC, Lee B, Mirzayan R. Novel technique for ulnar collateral ligament reconstruction of the elbow. Orthopedics 2012;35:947-51. https://doi.org/10.3928/01477447-20121023-05
  28. Callaway GH, Field LD, Deng XH, et al. Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone Joint Surg Am 1997;79:1223-31. https://doi.org/10.2106/00004623-199708000-00015
  29. Mullen DJ, Goradia VK, Parks BG, Matthews LS. A biomechanical study of stability of the elbow to valgus stress before and after reconstruction of the medial collateral ligament. J Shoulder Elbow Surg 2002;11:259-64. https://doi.org/10.1067/mse.2002.122622
  30. Ciccotti MG, Siegler S, Kuri JA 2nd, Thinnes JH, Murphy DJ 4th. Comparison of the biomechanical profile of the intact ulnar collateral ligament with the modified Jobe and the Docking reconstructed elbow: an in vitro study. Am J Sports Med 2009;37:974-81. https://doi.org/10.1177/0363546508331136
  31. Paletta GA Jr, Klepps SJ, Difelice GS, et al. Biomechanical evaluation of 2 techniques for ulnar collateral ligament reconstruction of the elbow. Am J Sports Med 2006;34:1599-603. https://doi.org/10.1177/0363546506289340
  32. McAdams TR, Lee AT, Centeno J, Giori NJ, Lindsey DP. Two ulnar collateral ligament reconstruction methods: the docking technique versus bioabsorbable interference screw fixation:a biomechanical evaluation with cyclic loading. J Shoulder Elbow Surg 2007;16:224-8. https://doi.org/10.1016/j.jse.2005.12.012
  33. Jackson A, Maerz T, Koueiter DM, Andrecovich CJ, Baker KC, Anderson K. Strength of ulnar fixation in ulnar collateral ligament reconstruction: a biomechanical comparison of traditional bone tunnels to the tension-slide technique. J Shoulder Elbow Surg 2012;21:1674-9. https://doi.org/10.1016/j.jse.2012.03.017
  34. Bernholt DL, Lake SP, Castile RM, Papangelou C, Hauck O, Smith MV. Biomechanical comparison of docking ulnar collateral ligament reconstruction with and without an internal brace. J Shoulder Elbow Surg 2019;28:2247-52. https://doi.org/10.1016/j.jse.2019.04.061
  35. Bodendorfer BM, Looney AM, Lipkin SL, et al. Biomechanical comparison of ulnar collateral ligament reconstruction with the docking technique versus repair with internal bracing. Am J Sports Med 2018;46:3495-501. https://doi.org/10.1177/0363546518803771
  36. Leasure J, Reynolds K, Thorne M, Escamilla R, Akizuki K. Bio-mechanical comparison of ulnar collateral ligament reconstruction with a modified docking technique with and without suture augmentation. Am J Sports Med 2019;47:928-32. https://doi.org/10.1177/0363546518820304
  37. 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;44:735-41. https://doi.org/10.1177/0363546515620390
  38. Jones CM, Beason DP, Dugas JR. Ulnar collateral ligament reconstruction versus repair with internal bracing: comparison of cyclic fatigue mechanics. Orthop J Sports Med 2018;6:2325967118755991.
  39. 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;42:536-43. https://doi.org/10.1177/0363546513510890
  40. 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;42:880-5. https://doi.org/10.1177/0363546513519072
  41. Lansdown DA, Feeley BT. The effect of ulnar collateral ligament reconstruction on pitch velocity in Major League Baseball pitchers. Orthop J Sports Med 2014;2:2325967114522592.
  42. Ahmad CS, Grantham WJ, Greiwe RM. Public perceptions of Tommy John surgery. Phys Sportsmed 2012;40:64-72. https://doi.org/10.3810/psm.2012.05.1966
  43. 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;40:1578-82. https://doi.org/10.1177/0363546512446927
  44. Erickson BJ, Bach BR Jr, Cohen MS, et al. Ulnar collateral ligament reconstruction: the rush experience. Orthop J Sports Med 2016;4:2325967115626876.
  45. 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;47:1096-102. https://doi.org/10.1177/0363546519833684
  46. 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;40:2249-54. https://doi.org/10.1016/j.jhsa.2015.07.024