Ulnar Collateral Ligament Repair With Suture Bridge Augmentation

Urch, Ekaterina; DeGiacomo, Anthony; Photopoulos, Christos; Limpisvasti, Orr; ElAttrache, Neal S.

doi:10.1016/j.eats.2017.08.080

Cited by 12 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Dugas et al 7 described a technique of repairing a torn UCL with suture tape (now called internal brace) augmentation. There have been other techniques described, 13 , 14 , 19 – 22 all with the same indications of acute UCL injury with good ligamentous quality. In a study by Rothermich et al 18 of Division 1 National Collegiate Athletic Association baseball players who underwent UCL surgery, the proportion of patients who underwent UCL repair increased each year, from 10% in 2017, to 20% in 2018, and 25% in 2019.…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

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

View full text Add to dashboard Cite

show abstract

“…Savoie et al [30] published a case series retrospectively evaluating young athletes (mean age: 17.2 years) who had excellent overall outcomes after UCL repair. In addition, in recent years, newer UCL repair techniques have been developed and promoted [4,7,32]. Thus, UCL repair is now advocated for certain patients, such as for younger athletes with proximal or distal avulsion UCL injuries [7,31,32].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, in recent years, newer UCL repair techniques have been developed and promoted [4,7,32]. Thus, UCL repair is now advocated for certain patients, such as for younger athletes with proximal or distal avulsion UCL injuries [7,31,32]. In prior years, UCL reconstruction procedures would have been utilized preferentially for these athletes.…”

Section: Introductionmentioning

confidence: 99%

Trends in Medial Ulnar Collateral Ligament Repair and Reconstruction From 2007 to 2016: A Population-Based Study of a Large Private Insurance Database

Baron

Westermann

DeMik

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

Background: Ulnar collateral ligament (UCL) reconstruction and UCL repair of the elbow are commonly performed procedures, resulting in high return-to-play rates. Whether the incidence rate of UCL reconstruction vs UCL repair has changed over time is not currently known. Purpose/Questions: We sought to assess temporal trends in the incidence rates of UCL repair and UCL reconstruction and to identify factors associated with UCL reconstruction. We hypothesized that UCL repair would demonstrate an increased incidence overall in recent years with an associated decline in UCL reconstruction rates. Methods: Using the PearlDiver Research Program to query the Humana administrative claims database, we identified patients who had undergone UCL repair and/or reconstruction from 2007 to 2016. Patients were stratified by age (15–19; 20–29; 30–49 years), sex, and year (2007–2011 vs 2012–2016). Poisson regression analysis (continuous variables) was used to calculate the incidence risk ratio (IRR); chi-square tests were performed for categorical variables, and odds ratios were calculated with 95% confidence intervals (CI). Results: The incidence rate of UCL repair was greater in 2012–2016 than in 2007–2011 (IRR: 1.86, 95% CI: 1.16–2.96). The incidence rate of UCL reconstruction vs UCL repair was greater for patients aged 15 to 19 years (IRR: 3.37, 95% CI: 1.97–5.77) but not patients aged 20 to 29 years (IRR: 0.89, 95% CI: 0.49–1.59) as compared with patients aged 30 to 49. Males aged 19 years were more likely than females to undergo UCL reconstruction (IRR: 10.09, 95% CI: 1.37–3.45). Conclusion: While UCL procedures are becoming more popular, our retrospective analysis showed that young males are preferentially treated with UCL reconstruction, warranting further investigation into these trends.

show abstract

“…20 One area of potential improvement is the ulnar attachment during reconstruction. Rather than a simple attachment on the sublime tubercle, the ligament insertion tapers as it extends distally along a consistent osseous ridge, with a mean length of 27.4 to 29.2 mm, 9,19 a mean width of 4.0 to 7.6 mm, 1,17 and an average insertional area of 187.6 mm. 3,4,9 As a result, surgeons have considered moving their reconstruction position more distally.…”

mentioning

confidence: 99%

Comparison of a Novel Anatomic Technique and the Docking Technique for Medial Ulnar Collateral Ligament Reconstruction

Meyers

Middleton

et al. 2022

Am J Sports Med

View full text Add to dashboard Cite

Background: Current reconstruction techniques do not re-create the distal ulnar collateral ligament (UCL) insertion. Reconstructing the distal extension of the anterior band ulnar footprint may increase elbow stability and resistance against valgus stress after UCL reconstruction (UCLR). Purpose/Hypothesis: The purpose was to test a new technique for UCLR, a modification of the docking technique, aimed at re-creating the distal ulnar footprint anatomy of the anterior band. We hypothesize that this novel “anatomic” technique will provide greater resistance to valgus stress after UCLR when compared with the docking technique. Study Design: Descriptive laboratory study. Methods: Eighteen unpaired cadaveric arms were dissected to capsuloligamentous elbow structures and potted. With use of a servohydraulic load frame, 5 Nċm of valgus stress was placed on the UCL-intact elbows at 30°, 60°, 90°, and 120° of flexion. UCLR was performed on each elbow, randomized to either the docking technique or the anatomic technique. After UCLR, the elbow was again tested at 30°, 60°, 90°, and 120° of flexion. Ulnohumeral joint gapping was calculated using a 3-dimensional motion capture system applied to markers attached to the ulna and humerus. Differences in gapping among the intact state and docking and anatomic techniques were compared using a 2-way analysis of variance with significance set to P < .05. Results: There was no significant difference in gapping between the anatomic and docking technique groups regardless of elbow flexion angle. All reconstructed groups showed increased gapping relative to intact, but all increases were below the clinically relevant level of 1 mm. Conclusion: Ulnohumeral joint gapping and resistance to valgus stress were similar between the anatomic technique and the docking technique for UCLR. Clinical Relevance: This study provides evidence that the anatomic technique is a viable alternative UCLR method as compared with the docking technique in a cadaveric model.

show abstract

Ulnar Collateral Ligament Repair With Suture Bridge Augmentation

Cited by 12 publications

References 21 publications

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

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

Trends in Medial Ulnar Collateral Ligament Repair and Reconstruction From 2007 to 2016: A Population-Based Study of a Large Private Insurance Database

Comparison of a Novel Anatomic Technique and the Docking Technique for Medial Ulnar Collateral Ligament Reconstruction

Contact Info

Product

Resources

About