nach oben

Current Reviews in Musculoskeletal Medicine

Erschienen in:

20.04.2020 | Injuries in Overhead Athletes (J Dines and C Camp, Section Editors)

The History and Evolution of Elbow Medial Ulnar Collateral Ligament Reconstruction: from Tommy John to 2020

verfasst von: Andrew R. Jensen, Matthew D. LaPrade, Travis W. Turner, Joshua S. Dines, Christopher L. Camp

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 3/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The purpose of this review article is to discuss the evolution of surgical reconstruction of the anterior bundle of the UCL, otherwise known as Tommy John surgery, from Dr. Jobe’s initial description in 1986 to present day. In particular, the unique changes brought forth by each new surgical technique, and the reasons that these changes were implemented, are highlighted.

Recent Findings

The incidence of UCL reconstruction surgery continues to increase significantly, particularly in the 15- to 19-year-old age group. New anatomic understanding of the anterior bundle of the UCL, including the importance of the central fibers and the broad and tapered ulnar insertion, may affect optimal UCL reconstruction techniques in the future. Although return to play rates are generally quite high (80–95%), the mean time to return to play (typically 12–18 months for pitchers) is longer than desired. Accordingly, many authors feel that there remains room for improvement in the treatment of this common injury.

Summary

The Tommy John surgery has evolved in many ways with the development of novel techniques over the last 35 years. Currently, overhead throwing athletes undergoing UCL reconstruction have high return to play and low complication rates. Future modifications to the surgery may aim to further improve outcomes and, more importantly, expedite the length of postoperative rehabilitation.

Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, et al. Ulnar collateral ligament reconstruction: anatomy, indications, techniques, and outcomes. Sports Health. 2015;7(6):511–7. https://doi.org/10.1177/1941738115607208.CrossRefPubMedPubMedCentral

McGraw MA, Kremchek TE, Hooks TR, Papangelou C. Biomechanical evaluation of the docking plus ulnar collateral ligament reconstruction technique compared with the docking technique. Am J Sports Med. 2013;41(2):313–20. https://doi.org/10.1177/0363546512466375.CrossRefPubMed

Hechtman KS, Tjin ATEW, Zvijac JE, Uribe JW, Latta LL. Biomechanics of a less invasive procedure for reconstruction of the ulnar collateral ligament of the elbow. Am J Sports Med. 1998;26(5):620–4. https://doi.org/10.1177/03635465980260050401.CrossRefPubMed

Armstrong AD, Dunning CE, Faber KJ, Johnson JA, King GJ. Single-strand ligament reconstruction of the medial collateral ligament restores valgus elbow stability. J Shoulder Elb Surg. 2002;11(1):65–71. https://doi.org/10.1067/mse.2002.120392.CrossRef

Chen FS, Rokito AS, Jobe FW. Medial elbow problems in the overhead-throwing athlete. J Am Acad Orthop Surg. 2001;9(2):99–113.CrossRefPubMed

• Chang ES, Dodson CC, Ciccotti MG. Comparison of surgical techniques for ulnar collateral ligament reconstruction in overhead athletes. J Am Acad Orthop Surg. 2016;24(3):135–49. https://doi.org/10.5435/jaaos-d-14-00323. An excellent review of the different surgical techniques used to perform UCL reconstruction. CrossRefPubMed

• Looze CA, Strauss EJ, Jazrawi LM. Ulnar collateral ligament reconstruction past, present, and future. Bull Hosp Jt Dis. 2018;76(1):22–6. An excellent review of the history of UCL reconstruction surgery.

•• Camp CL, Conte S, D’Angelo J, Fealy SA. Epidemiology of ulnar collateral ligament reconstruction in major and minor league baseball pitchers: comprehensive report of 1429 cases. J Shoulder Elb Surg. 2018;27(5):871–8. https://doi.org/10.1016/j.jse.2018.01.024. This retrospective study evaluated every known UCL reconstruction performed in professional baseball players from 1978 to 2016. The authors found that 1429 UCL reconstructions had been performed and 83.7% of players returned to play. CrossRefPubMed

•• Camp CL, Conte S, D’Angelo J, Fealy SA. Following ulnar collateral ligament reconstruction, professional baseball position players return to play faster than pitchers, but catchers return less frequently. J Shoulder Elb Surg. 2018;27(6):1078–85. https://doi.org/10.1016/j.jse.2018.01.023. This retrospective study reported the outcomes of positional players (non-pitchers) in professional baseball. The authors found that 168 UCL reconstructions had been performed in positional players from 1984 to 2015 and 75.5% of positional players returned to play. CrossRefPubMed

10.

Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am. 1986;68(8):1158–63.CrossRefPubMed

11.

Watson JN, McQueen P, Hutchinson MR. A systematic review of ulnar collateral ligament reconstruction techniques. Am J Sports Med. 2014;42(10):2510–6. https://doi.org/10.1177/0363546513509051.CrossRefPubMed

12.

Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74(1):67–83.CrossRefPubMed

13.

Andrews JR, Timmerman LA. Outcome of elbow surgery in professional baseball players. Am J Sports Med. 1995;23(4):407–13. https://doi.org/10.1177/036354659502300406.CrossRefPubMed

14.

Cain EL Jr, Andrews JR, Dugas JR, Wilk KE, McMichael CS, Walter JC 2nd, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426–34. https://doi.org/10.1177/0363546510378100.CrossRefPubMed

15.

Smith GR, Altchek DW, Pagnani MJ, Keeley JR. A muscle-splitting approach to the ulnar collateral ligament of the elbow. Neuroanatomy and operative technique. Am J Sports Med. 1996;24(5):575–80. https://doi.org/10.1177/036354659602400503.CrossRefPubMed

16.

Thompson WH, Jobe FW, Yocum LA, Pink MM. Ulnar collateral ligament reconstruction in athletes: muscle-splitting approach without transposition of the ulnar nerve. J Shoulder Elb Surg. 2001;10(2):152–7. https://doi.org/10.1067/mse.2001.112881.CrossRef

17.

Vitale MA, Ahmad CS. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Am J Sports Med. 2008;36(6):1193–205. https://doi.org/10.1177/0363546508319053.CrossRefPubMed

18.

•• Donohue BF, Lubitz MG, Kremchek TE. Elbow ulnar collateral ligament reconstruction using the novel docking plus technique in 324 athletes. Sports Med Open. 2019;5(1):3. https://doi.org/10.1186/s40798-018-0174-8. This retrospective study reported the clinical results of 324 patients who had undergone UCL reconstruction via the docking plus technique. The authors found that 90.9% of patients returned to play and that there was a retear rate of 2.5%.

19.

Rohrbough JT, Altchek DW, Hyman J, Williams RJ 3rd, Botts JD. Medial collateral ligament reconstruction of the elbow using the docking technique. Am J Sports Med. 2002;30(4):541–8. https://doi.org/10.1177/03635465020300041401.CrossRefPubMed

20.

Dodson CC, Thomas A, Dines JS, Nho SJ, Williams RJ 3rd, Altchek DW. Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes. Am J Sports Med. 2006;34(12):1926–32. https://doi.org/10.1177/0363546506290988.CrossRefPubMed

21.

Dines JS, Jones KJ, Kahlenberg C, Rosenbaum A, Osbahr DC, Altchek DW. Elbow ulnar collateral ligament reconstruction in javelin throwers at a minimum 2-year follow-up. Am J Sports Med. 2012;40(1):148–51. https://doi.org/10.1177/0363546511422350.CrossRefPubMed

22.

Jones KJ, Dines JS, Rebolledo BJ, Weeks KD, Williams RJ, Dines DM, et al. Operative management of ulnar collateral ligament insufficiency in adolescent athletes. Am J Sports Med. 2014;42(1):117–21. https://doi.org/10.1177/0363546513507695.CrossRefPubMed

23.

•• Erickson BJ, Bach BR Jr, Cohen MS, Bush-Joseph CA, Cole BJ, Verma NN, et al. Ulnar collateral ligament reconstruction: the rush experience. Orthop J Sports Med. 2016;4(1):2325967115626876. https://doi.org/10.1177/2325967115626876. This retrospective study reported the clinical results of 187 patients who had undergone UCL reconstruction via the docking technique or the Rush modification of the double-docking technique. The authors found 94.1% good or excellent Conway scores and 5.3% rate of subsequent surgeries. CrossRef

24.

Griffith TB, Ahmad CS, Gorroochurn P, D’Angelo J, Ciccotti MG, Dines JS, et al. Comparison of outcomes based on graft type and tunnel configuration for primary ulnar collateral ligament reconstruction in professional baseball pitchers. Am J Sports Med. 2019;47(5):1103–10. https://doi.org/10.1177/0363546519831705.CrossRefPubMed

25.

Koh JL, Schafer MF, Keuter G, Hsu JE. Ulnar collateral ligament reconstruction in elite throwing athletes. Arthroscopy. 2006;22(11):1187–91. https://doi.org/10.1016/j.arthro.2006.07.024.CrossRefPubMed

26.

Bowers AL, Dines JS, Dines DM, Altchek DW. Elbow medial ulnar collateral ligament reconstruction: clinical relevance and the docking technique. J Shoulder Elb Surg. 2010;19(2 Suppl):110–7. https://doi.org/10.1016/j.jse.2010.01.005.CrossRef

27.

Paletta GA Jr, Klepps SJ, Difelice GS, Allen T, Brodt MD, Burns ME, et al. Biomechanical evaluation of 2 techniques for ulnar collateral ligament reconstruction of the elbow. Am J Sports Med. 2006;34(10):1599–603. https://doi.org/10.1177/0363546506289340.CrossRefPubMed

28.

Paletta GA Jr, Wright RW. The modified docking procedure for elbow ulnar collateral ligament reconstruction: 2-year follow-up in elite throwers. Am J Sports Med. 2006;34(10):1594–8. https://doi.org/10.1177/0363546506289884.CrossRefPubMed

29.

Hechtman KS, Zvijac JE, Wells ME, Botto-van BA. Long-term results of ulnar collateral ligament reconstruction in throwing athletes based on a hybrid technique. Am J Sports Med. 2011;39(2):342–7. https://doi.org/10.1177/0363546510385401.CrossRefPubMed

30.

Ahmad CS, Lee TQ, ElAttrache NS. Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation. Am J Sports Med. 2003;31(3):332–7. https://doi.org/10.1177/03635465030310030201.CrossRefPubMed

31.

Furukawa K, Pichora J, Steinmann S, Faber KJ, Johnson JA, King GJ. Efficacy of interference screw and double-docking methods using palmaris longus and GraftJacket for medial collateral ligament reconstruction of the elbow. J Shoulder Elb Surg. 2007;16(4):449–53. https://doi.org/10.1016/j.jse.2006.09.020.CrossRef

32.

Kodde IF, Rahusen FT, Eygendaal D. Long-term results after ulnar collateral ligament reconstruction of the elbow in European athletes with interference screw technique and triceps fascia autograft. J Shoulder Elb Surg. 2012;21(12):1656–63. https://doi.org/10.1016/j.jse.2012.07.010.CrossRef

33.

Jackson TJ, Adamson GJ, Peterson A, Patton J, McGarry MH, Lee TQ. Ulnar collateral ligament reconstruction using bisuspensory fixation: a biomechanical comparison with the docking technique. Am J Sports Med. 2013;41(5):1158–64. https://doi.org/10.1177/0363546513481957.CrossRefPubMed

34.

Armstrong AD, Dunning CD, Ferreira LM, Faber KJ, Johnson JA, King GJ. A biomechanical comparison of four reconstruction techniques for the medial collateral ligament-deficient elbow. J Shoulder Elb Surg. 2005;14(2):207–15.CrossRef

35.

Conway JE. The DANE TJ procedure for elbow medial ulnar collateral ligament insufficiency. Tech Shoulder and Elbow Surg. 2006;7(1):36–43.CrossRef

36.

Dines JS, ElAttrache NS, Conway JE, Smith W, Ahmad CS. Clinical outcomes of the DANE TJ technique to treat ulnar collateral ligament insufficiency of the elbow. Am J Sports Med. 2007;35(12):2039–44. https://doi.org/10.1177/0363546507305802.CrossRefPubMed

37.

Lynch JL, Pifer MA, Maerz T, Kurdziel MD, Davidson AA, Baker KC, et al. The GraftLink ulnar collateral ligament reconstruction: biomechanical comparison with the docking technique in both kinematics and failure tests. Am J Sports Med. 2013;41(10):2278–87. https://doi.org/10.1177/0363546513498999.CrossRefPubMed

38.

Lynch JL, Maerz T, Kurdziel MD, Davidson AA, Baker KC, Anderson K. Biomechanical evaluation of the TightRope versus traditional docking ulnar collateral ligament reconstruction technique: kinematic and failure testing. Am J Sports Med. 2013;41(5):1165–73. https://doi.org/10.1177/0363546513482567.CrossRefPubMed

39.

Dugas JR, Ostrander RV, Cain EL, Kingsley D, Andrews JR. Anatomy of the anterior bundle of the ulnar collateral ligament. J Shoulder Elb Surg. 2007;16(5):657–60. https://doi.org/10.1016/j.jse.2006.11.009.CrossRef

40.

Farrow LD, Mahoney AJ, Stefancin JJ, Taljanovic MS, Sheppard JE, Schickendantz MS. Quantitative analysis of the medial ulnar collateral ligament ulnar footprint and its relationship to the ulnar sublime tubercle. Am J Sports Med. 2011;39(9):1936–41. https://doi.org/10.1177/0363546511406220.CrossRefPubMed

41.

•• Camp CL, Jahandar H, Sinatro AM, Imhauser CW, Altchek DW, Dines JS. Quantitative anatomic analysis of the medial ulnar collateral ligament complex of the elbow. Orthop J Sports Med. 2018;6(3). https://doi.org/10.1177/2325967118762751. this anatomic study evaluated the anatomy of the anterior, posterior, and transverse bundles of the UCL using advanced imaging. The authors found that the insertion of the anterior bundle was larger, more elongated, and more tapered than previously thought. CrossRef

42.

•• Camp CL, Bernard C, Benavitz B, Konicek J, Altchek DW, Dines JS. Reconstruction of the medial ulnar collateral ligament of the elbow: biomechanical comparison of a novel anatomic technique to the docking technique. Orthop J Sports Med. https://doi.org/10.1177/2325967119857592. This biomechanical study reported a novel UCL reconstruction technique whereby the ulnar insertion of the anterior bundle of the UCL is fixed via suture anchors and Endobutton device to restore the broad ulnar insertion of the anterior bundle of the UCL. The authors demonstrated improved biomechanical properties with this new anatomic technique as compared to the docking technique CrossRef

43.

Makhni EC, Lee RW, Morrow ZS, Gualtieri AP, Gorroochurn P, Ahmad CS. Performance, return to competition, and reinjury after Tommy John surgery in Major League Baseball pitchers: a review of 147 cases. Am J Sports Med. 2014;42(6):1323–32. https://doi.org/10.1177/0363546514528864.CrossRefPubMed

44.

•• Camp CL, Dines JS, van der List JP, Conte S, Conway J, Altchek DW, et al. Summative report on time out of play for major and minor league baseball: an analysis of 49,955 injuries from 2011 through 2016. Am J Sports Med. 2018;46(7):1727–32. https://doi.org/10.1177/0363546518765158. This retrospective study analyzed nearly 50,000 injuries in professional baseball players from 2011 to 2016. The authors found that the incidence of injuries remained steady through the study period. CrossRefPubMed

45.

•• Dugas JR, Looze CA, Capogna B, Walters BL, Jones CM, Rothermich MA, et al. Ulnar collateral ligament repair with collagen-dipped FiberTape augmentation in overhead-throwing athletes. Am J Sports Med. 2019;47(5):1096–102. https://doi.org/10.1177/0363546519833684. This retrospective study evaluated the clinical outcomes of 111 patients with proximal or distal avulsion injuries of the UCL who had undergone UCL repair with internal brace. The authors found a 92% return to play rate at an average of 6.7 months. CrossRefPubMed

46.

Savoie FH 3rd, Trenhaile SW, Roberts J, Field LD, Ramsey JR. Primary repair of ulnar collateral ligament injuries of the elbow in young athletes: a case series of injuries to the proximal and distal ends of the ligament. Am J Sports Med. 2008;36(6):1066–72. https://doi.org/10.1177/0363546508315201.CrossRefPubMed

47.

•• Jones CM, Beason DP, Dugas JR. Ulnar collateral ligament reconstruction versus repair with internal bracing: comparison of cyclic fatigue mechanics. Orthop J Sports Med. 2018;6(2):2325967118755991. https://doi.org/10.1177/2325967118755991. This biomechanical study evaluated the properties of UCL repair with internal bracing compared to UCL reconstruction via the modified Jobe technique. The authors found that UCL repair was more resistant to gap formation under fatigue loading than the modified Jobe reconstruction. CrossRef

Titel: The History and Evolution of Elbow Medial Ulnar Collateral Ligament Reconstruction: from Tommy John to 2020
verfasst von: Andrew R. Jensen
Matthew D. LaPrade
Travis W. Turner
Joshua S. Dines
Christopher L. Camp
Publikationsdatum: 20.04.2020
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 3/2020
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09618-y

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

23.04.2024 | Leitsymptom Rückenschmerzen | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

The History and Evolution of Elbow Medial Ulnar Collateral Ligament Reconstruction: from Tommy John to 2020

Abstract

Purpose of Review

Recent Findings

Summary

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2020

State of the Union on Ulnar Collateral Ligament Reconstruction in 2020: Indications, Techniques, and Outcomes

Hamstring Autograft for Lateral Ligament Stabilization

Approach to a Failed Hip Arthroscopy

Survivorship Following Hip Arthroscopy: Lessons Learned from a Comprehensive Database

Anterior Cruciate Ligament Re-tear and Revision Reconstruction in the Skeletally Immature Athlete

Return to Play After a Lateral Ligament Ankle Sprain

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie