Ulnar Collateral Ligament Repair with Internal Brace Augmentation

Abstract

Objectives:Objective: Our purpose is to describe a novel surgical technique for Ulnar Collateral Ligament repair in the young adolescent, and present the clinical results of a retrospective cohort of patients. We hypothesized that using an internal brace to augment the repair of the native ulnar collateral ligament would allow for a more aggressive physical therapy protocol and ultimately facilitate both an expeditious return to sport and a high level of patient satisfaction.Methods:Methods: After obtaining IRB approval for this study, our institutional electronic database was utilized to identify all patients who had undergone our novel technique for UCL repair between the years 2013-2014. An orthopedic fellow conducted phone surveys and the KJOC questionnaire was administered. Primary outcome measures included KJOC scores at 6 and 12 months, time to initiation of a plyometrics regimen, an interval throwing program and return to sports. Secondary measures including patient satisfaction, level of competition achieved and percent return to normal were also collected.Results:Results: Twenty-two patients (19 male/3 female, average age 17.8 years) underwent surgery between 2013-2014. All patients were high school level athletes at the time of injury and included nineteen baseball players (13 pitchers), two football players, a javelin thrower and a cheerleader. Injury patterns included seven proximal tears, one mid substance, thirteen distal and four avulsions. Nine patients underwent ulnar transposition at the time of surgery, one had undergone prior transposition and the remainder of the patient’s ulnar nerves were left in situ. At six and twelve months the average KJOC scores respectively were 88.3 and 93. Patients that underwent transposition had KJOC scores of 78.3 at six months and 97.5 at twelve while patients that were left in-situ scored 82 and 91. These differences were not significant. The average number of weeks until initiation of plyometrics was seven and an interval throwing program was initiated on average, by week eleven. The average time to throwing from the mound was twenty weeks and full return to sports was twenty-one. Twelve of the thirteen pitchers made it back to the same or next level and six of them did so by transitioning from another position back to pitcher. The remaining athletes in the cohort all returned to competition at their pre injury level. At six months all but one patient was “very” satisfied and at twelve months, all were satisfied. At six months, patients deemed themselves to be at 92% normal and at twelve months, 96%.Conclusion:Conclusion: Recently, there have been an increasing number of throwing athletes with injuries to the ulnar collateral ligament (UCL) and a seemingly exponential rise amongst adolescents. The argument for repair rather than reconstruction in younger athletes is supported by both the observation that ligaments in these patients are absent the chronic attritional damage and secondary pathologic joint changes so frequently observed in injuries amongst highe...

Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction With the Docking Technique Versus Repair With Internal Bracing

“…One final consideration and caution: These biomechanical results do not suggest any effect on a patient’s clinical outcome. However, Walters et al 34 showed a 92% return to play at 6 months, which is a higher rate than most studies on UCL reconstruction. However, the long-term performance remains unknown.…”

“…6,12,13,17,26,28 Although nonoperative management is an option, faster return to play makes operative care of UCL ruptures desirable for both patients and parents. 1,15,20,34…”

“…In an effort to improve on primary repair of the UCL, augmentation techniques were developed and first described by Walters et al 34 Dugas et al 12 conducted a biomechanical study comparing primary UCL repair reinforced with an internal brace and modified Jobe reconstruction and found no significant difference in ultimate torque or gapping. Walters et al reported excellent results in 22 young athletes, with 92% and 96% returning to play at 6 and 12 months, respectively.…”

Factors Important to Patient Decision-Making After Ulnar Collateral Ligament Injury in Competitive High School and Collegiate Baseball Players

“…Indeed, the anticipated length of recovery depends on the procedure. Position players typically return to play at around 6 months after a UCL repair, 6,7,13,17 as compared with 9 to 12 months after a UCL reconstruction. 1,12 The anticipated length of recovery also depends on whether the patient is a pitcher and wants to return to pitching.…”

Repair of the Medial Ulnar Collateral Ligament of the Elbow With Internal Brace Augmentation

“…Multiple studies now published on clinical outcomes of MUCL repair with internal brace augmentation, [1][2][3][4][5][6]10 and a recent study by Dugas et al 3,4 reported favorable outcomes for 111 patients who had a 92% return to play rate at a mean time of 6.7 months.…”