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Elbow Ulnar Collateral Ligament Shoelace Repair with Internal Bracing for Treating Throwing Athletes Who Have Ulnar Collateral Ligament Instability.

ABSTRACT: This Technical Note aimed to present a surgical technique of ulnar collateral ligament (UCL) shoelace repair using suture anchors and double suture tapes in combination with internal bracing to correct UCL instability along with epiphyseal avulsion of the medial epicondyle in throwing athletes Skeletally immature throwing athletes playing baseball and softball are at a risk of sustaining medial epicondyle epiphyseal separation that can result in UCL instability, predisposing to elbow UCL disruption later. There are several surgical techniques that can restore elbow UCL function and stability. In cases where large fragments of the medial epicondyle are present in skeletally immature athletes, the residual bony fragment and the shortened, chronically injured UCL make surgical treatment quite challenging. Recent studies have shown that UCL repair with internal bracing can effectively treat acute UCL injury. However, this procedure is not ideal for restoring large disruption of the UCL such as fragmentation. Here, we present a surgical technique of UCL shoelace repair using suture anchors with double suture tapes in combination with internal bracing for correcting UCL instability concurrent with epiphyseal fragmentation of medial epicondyle in throwing athletes.

SUBMITTER: Uchida S

PROVIDER: S-EPMC8322694 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVE:Several studies have been published regarding the treatment of medial ulnar collateral ligament (MUCL) injuries for professional overhead athletes. However, there is a paucity of data regarding non-professional athletes. The aim of this systematic review was to compare the rate of outcome scores and complications of conservative versus operative treatments both in non-professional athletes and in non-sport-related trauma patients with MUCL lesions. METHODS:A systematic review of the published literature was performed by applying the PRISMA guidelines. A search was conducted using three databases: Medline, Science Direct, and Web of Science. The keywords used were "ulnar collateral ligament injury," "elbow," "surgery," and "conservative treatment". Patients were divided into three groups: patients who underwent conservative treatment (C-group), surgical treatment (S-group), and surgery after a failed conservative treatment (C&S-group). Clinical outcomes were analyzed: Disability of Arm, Shoulder and Hand (DASH), Conway scale, Carson score, and Kerlan-Jobe Orthopaedic Clinic score (KJOC). RESULTS:A total of 15 studies were included, evaluating 513 patients. Although good and excellent outcomes were found for most patients during daily and/or sport activities, independently of the type of treatment, the C-group had better results. Excellent results were found in 98.8% of the C-group, in 88.1% of the S-group, and in 87.7% of the C&S-group. The complication rate in the C-group was statistically higher compared to the S and C&S groups (P < 0.001). However, its complication rate was higher with lower patient satisfaction. CONCLUSIONS:There is insufficient evidence to establish statistically significant differences in the effects of conservative versus surgical treatments on the functional outcomes of patients with MUCL lesions. However, a period of rehabilitation therapy and the functional request of the single injured subject are useful to discern which patients genuinely require MUCL surgical repair.

Project description:PurposeTo evaluate the incidence of early postoperative complications and revision surgery in patients who underwent primary medial ulnar collateral ligament (MUCL) repair with minimum of 2-year follow-up.MethodsA retrospective review of a national insurance database was conducted to identify patients with MUCL injuries who underwent primary MUCL repair between 2015 to 2020 with minimum 2-year follow-up. Patients >40 years of age and those who had concomitant elbow fractures or dislocations, lateral UCL injures, medial epicondylitis, elbow arthritis, or a history of previous elbow injury/surgery were excluded. The number of patients who underwent a concomitant ulnar nerve procedure (transposition or decompression) during the primary MUCL repair was recorded. Complications within 90 days of surgery and the incidence and timing of subsequent ipsilateral ulnar nerve surgery or revision MUCL surgery were assessed.ResultsA total of 313 patients (63.6% male) were included. The mean age was 20.3 ± 6.9 years, and mean follow-up was 3.7 ± 1.3 years. Concomitant ulnar nerve transposition or decompression was performed in 34.2% (N = 107). The early postoperative complication rate was 7.3% (N = 23). The most common complication was ulnar neuropathy (5.8%, N = 18). Wound complications, elbow stiffness, and medial epicondyle fractures were much less common (N = 5). Sixteen of 18 (88.9%) patients with postoperative ulnar neuropathy underwent transposition or decompression at the time of primary repair. Of these 18 patients, 5 (27.8%) underwent a subsequent ulnar nerve surgery (1 primary and 4 secondary), with the majority occurring within 6 months. The incidence of revision MUCL surgery was low (1.0%, N=3), with all 3 patients undergoing MUCL reconstruction.ConclusionThere was a low incidence of early postoperative complications (7.3%) and 2-year revision MUCL surgery (1.0%) in young patients who underwent primary MUCL repair with no additional ligamentous, fracture, and dislocation-related diagnoses. All 3 (1.0%) MUCL revisions underwent reconstruction.Level of evidenceLevel IV, therapeutic case series.

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Elbow Ulnar Collateral Ligament Shoelace Repair with Internal Bracing for Treating Throwing Athletes Who Have Ulnar Collateral Ligament Instability.

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