The Effect of Ulnar Collateral Ligament Repair With Internal Brace Augmentation on Articular Contact Mechanics: A Cadaveric Study

Roth, Travis S.; Beason, David P.; Clay, T. Bradley; Cain, E. Lyle; Dugas, Jeffrey R.

doi:10.1177/23259671211001069

Cited by 17 publications

(20 citation statements)

References 35 publications

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“…However, these studies also showed greater resistance to gap formation during subfailure fatigue testing in the repair group. 39,42 Roth et al 23 in 2021 examined the effect on joint contact mechanics in an augmented repair and a modified Jobe reconstruction technique. They noted no difference in contact pressures between the groups and no statistically significant difference from the intact state.…”

Section: Ucl Repair Techniques and Resultsmentioning

confidence: 99%

“…However, these studies also showed greater resistance to gap formation during subfailure fatigue testing in the repair group 39,42. Roth et al 23. in 2021 examined the effect on joint contact mechanics in an augmented repair and a modified Jobe reconstruction technique.…”

Section: Ucl Repair Techniques and Resultsmentioning

confidence: 99%

“…Repair and repair with augmentation using InternalBrace (Arthrex, Naples, FL) have demonstrated results that were comparable, and in some cases superior, to reconstruction over the past 5 yr with regard to return to play, extent of downtime, and biomechanical strength. 3,6,15,23 This article will examine recent findings, techniques, and trends in the utilization of UCL repair. This work was a review of available literature, and institutional review board approval for this research was not required.…”

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confidence: 99%

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Repair of the ulnar collateral ligament: a review of current trends and outcomes

Mackenzie¹,

Osbahr

2022

Current Orthopaedic Practice

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Diagnosis and surgical treatment of elbow ulnar collateral ligament (UCL) injury is becoming more common. A thorough understanding of nonsurgical and surgical options for this injury is required for successful treatment. Gold standard treatment remains ligamentous reconstruction with autograft in the elite throwing athlete. However, advances in surgical technique, technology, and a better understanding of the pathoanatomy of the injury have renewed interest in primary repair of the UCL. Recent literature has shown encouraging results with primary repair and with augmented primary repair, especially over the past 5 yr. This review describes the recent trends and outcomes of UCL repair so that surgeons can have a better understanding of surgical options.

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Section: Ucl Repair Techniques and Resultsmentioning

confidence: 99%

Section: Ucl Repair Techniques and Resultsmentioning

confidence: 99%

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confidence: 99%

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Repair of the ulnar collateral ligament: a review of current trends and outcomes

Mackenzie¹,

Osbahr

2022

Current Orthopaedic Practice

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“… 8 Additionally, native UCL repair with suture augmentation with an InternalBrace (Arthrex) has been shown to have equivalent time-zero biomechanical properties to the native ligament and reconstructed ligament using the docking and modified Jobe techniques. 2 , 9 , 13 , 21 Our technique also utilizes a high-strength suture acting as a biologic internal brace to allow partial shielding of valgus stress during the early repair phases of ligament healing. It is not beyond reason to assume that the biomechanical properties of native UCL repair extend to repairs of the UCL graft.…”

Section: Discussionmentioning

confidence: 99%

Outcomes After Medial Ulnar Collateral Ligament Graft Repair in Professional Baseball Pitchers With Minimum 2-Year Follow-up

Steffes

Heaps

ElAttrache

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Rerupture of the reconstructed ulnar collateral ligament (UCL) is becoming more frequent at the professional level of baseball. However, there is no literature describing outcomes after UCL graft repair. Purpose: To evaluate rerupture rate, return to play, performance upon return, and patient-reported outcomes after a novel UCL graft repair technique. Study Design: Case series; Level of evidence, 4. Methods: All included patients underwent UCL graft repair after a previous UCL reconstruction, pitched in at least 1 professional baseball game before repair, and were at least 2 years postprocedure within the same 10-year time period. The authors evaluated patient characteristics and performance metrics, including wins, losses, win percentage, earned run average, innings pitched, walks and hits per inning pitched, for the 2 seasons before and after the procedure. Patients were contacted to assess UCL rerupture, timing of return to sport, current level of competition, Conway score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score. Results: Six players met the inclusion criteria. All had proximal UCL graft ruptures and underwent flexor-pronator tendon repair in combination with graft repair. At a mean (±SD) follow-up of 56.7 ± 37.8 months, no reruptures were encountered, and the mean KJOC score was 87.9 ± 14.6. Of the 6 pitchers who underwent UCL graft repair, 4 (67%) returned to professional pitching at a mean of 17 ± 6 months. Three of the 6 (50%) achieved an excellent Conway score, signifying a return to prior level of sport. There was no significant difference in demographic or preoperative pitching performance metrics between players who did and did not return to pitching. For those players who returned to professional pitching, there was no significant difference between preprocedure and postprocedure performance statistics. Conclusion: Repair of the UCL graft appears to yield comparable rates of return to play and performance with revision UCL reconstruction. This technique serves as a viable alternative for proximal avulsion ruptures of the UCL graft.

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“…The prepared specimens were then loaded into a custom testing fixture that was previously described as appropriate for UCL torque and contact pressure testing. 16 This was mounted into a servohydraulic mechanical test frame (MTS Systems) with torsional capabilities. The elbow joint was distracted minimally in approximately 30° to 45° of flexion to allow for insertion of a single branch of the pressure sensor into the ulnohumeral joint space ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

Intersurgeon Consistency of Ulnar Collateral Ligament Repair With Internal Brace: A Biomechanical Analysis

Kouk

Beason

Rothermich

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Injury to the ulnar collateral ligament (UCL) of the medial elbow has been treated successfully with ligament repair augmented with internal brace. Previous work has shown that this procedure does not overconstrain the ulnohumeral joint; however, the procedures were conducted by a single surgeon, which controlled for anchor placement and graft tensioning. Purpose/Hypothesis: Our purpose was to evaluate the reproducibility of contact mechanics and joint torque after UCL repair with internal brace as performed by different surgeons compared with repair by a single surgeon. It was hypothesized that there would be no significant difference in elbow contact mechanics, valgus torque, or torsional stiffness between the 2 groups. Study Design: Controlled laboratory study. Methods: Nine pairs of fresh-frozen cadaveric elbows were tested biomechanically under 3 conditions: UCL-intact (UCL-I), UCL-deficient (UCL-D), and UCL-repaired with internal brace augmentation (UCLR-IB). For each pair, 1 elbow was repaired by a single surgeon, and the contralateral elbow was repaired by 1 of 9 other surgeons. Testing consisted of valgus torsion between 0° and 5° with the elbow positioned at 90° of flexion. Ulnohumeral contact mechanics and overall joint torque and stiffness were measured and compared between surgeon groups. Results: There were no statistically significant differences between the single-surgeon and multiple-surgeon groups regarding contact area ( P = .83), contact force ( P = .27), peak pressure ( P = .26), or peak force ( P = .30); however, contact pressure was significantly affected ( P = .02) by surgeon group. Compared with UCL-I, both UCL-D and UCLR-IB conditions had a significant overall effect on contact area ( P = .004) and contact force ( P = .05); however, contact pressure ( P = .56), peak pressure ( P = .27), and peak force ( P = .24) were not affected by injury condition. Measurements of elbow torque ( P = .28) and stiffness ( P = .98) were not significantly different between surgeon groups. Conclusion: UCL repair with internal brace provided consistent results among several surgeons when compared with a single surgeon. The procedure did not lead to joint overconstraint while also returning the ligament to near-intact levels of resisting valgus stress. Clinical Relevance: UCL repair with internal brace augmentation is a reproducible surgical technique that has good clinical outcomes in the literature.

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The Effect of Ulnar Collateral Ligament Repair With Internal Brace Augmentation on Articular Contact Mechanics: A Cadaveric Study

Cited by 17 publications

References 35 publications

Repair of the ulnar collateral ligament: a review of current trends and outcomes

Repair of the ulnar collateral ligament: a review of current trends and outcomes

Outcomes After Medial Ulnar Collateral Ligament Graft Repair in Professional Baseball Pitchers With Minimum 2-Year Follow-up

Intersurgeon Consistency of Ulnar Collateral Ligament Repair With Internal Brace: A Biomechanical Analysis

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