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Purpose Surgical reconstruction of the adult anterior bundle of the medial ulnar collateral elbow ligament (UCL) is a common and established treatment that yields satisfactory results. Children sustain these injuries less frequently, and surgical intervention is complicated by the juxtaposed medial epicondyle apophysis. The purpose of this study was to identify the anatomical origin of the pediatric UCL and determine if this location changes with elbow maturity. Methods A retrospective analysis of children with an elbow MRI between 2009 and 2012 was performed. Ninety children (68 boys, 22 girls), mean age 12.8 years (range 6-18), were grouped by age (\11, 11-13, and [13) and gender. Measurements of UCL width and UCL midpoint distance from medial epicondyle apophysis were recorded on coronal T1 images utilizing digital PACS software. Results Across all groups, boys had a wider UCL than girls (4.05 ± 0.16 mm vs 3.72 ± 0.20 mm, p = 0.03); however, there was no difference in the anatomical origin of the UCL relative to the medial epicondyle apophysis between gender (p = 0.52), between gender age-matched groups, or within gender age-matched groups. Yet, the anatomic origin of the UCL always remained medial to the cartilaginous interface of the apophysis with the osseous distal humerus and was centered approximately 3 mm medial to the lateral edge of the apophysis. Conclusion Regardless of age or gender, the humeral origin for the medial ulnar collateral ligament is medial to the interface between the medial epicondyle apophysis and distal humerus, which has surgical implications for anatomic reconstruction in children.

Introduction: Benign prostatic hyperplasia (BPH) is a common condition affecting aging men. While holmium laser enucleation of the prostate (HoLEP) is one of the most effective treatments for BPH, variations of the procedure, such as median lobe HoLEP (MLHoLEP), are rarely reported. Here, we report our institution’s experience with pHoLEP. Methods: Our institutional prospective database was queried for patients having undergone median or individual lateral lobe enucleation between 2007 and 2018. A control cohort of patients who underwent standard HoLEP (sHoLEP) was identified using 1:2 propensity score matching based on age, prostate size, maximal flow rate (Qmax), postvoid residual volume (PVR), and AUA symptom score (AUAss). Three and 12-month AUAss, PVR, and Qmax were compared. Results: Forty-seven patients were identified as having undergone MLHoLEP. At three-month followup, AUAss (p<0.01) and incontinence rates (p=0.045) were lower for MLHoLEP patients, in addition to them having shorter operative (36.5 mins vs. 64.5 mins, p<0.01) and enucleation (13.8 mins vs. 37 mins, p<0.01) times as compared to sHoLEP patients. No difference was noted between MLHoLEP and sHoLEP cohorts with respect to age, prostate volume, PVR, or Qmax. Significant improvement in AUAss, PVR, and Q max from baseline to three and 12 months was noted overall in both groups. Conclusions: MLHoLEP could provide a surgical option with reduced operative time, quicker improvement in AUAss and restored continence in appropriately selected patients. Ultimately, MLHoLEP represents a safe and effective treatment option to select patients who may not be eligible for or face potential morbidity concerns associated with sHoLEP.

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