98
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Current Concepts in Rehabilitation Following Ulnar Collateral Ligament Reconstruction

      review-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Injuries to the ulnar collateral ligament (UCL) in throwing athletes frequently occurs from the repetitive valgus loading of the elbow during the throwing motion, which often results in surgical reconstruction of the UCL requiring a structured postoperative rehabilitation program. Several methods are currently used and recommended for UCL reconstruction using autogenous grafts in an attempt to reproduce the stabilizing function of the native UCL. Rehabilitation following surgical reconstruction of the UCL begins with range of motion and initial protection of the surgical reconstruction, along with resistive exercise for the entire upper extremity kinetic chain. Progressions for resistive exercise are followed that attempt to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers, in addition to the distal upper extremity musculature, to allow for a return to throwing and overhead functional activities. Rehabilitation following UCL reconstruction has produced favorable outcomes, allowing for a return to throwing in competitive environments.

          Related collections

          Most cited references15

          • Record: found
          • Abstract: found
          • Article: not found

          Medial collateral ligament reconstruction of the elbow using the docking technique.

          Medial collateral ligament insufficiency of the elbow with resultant valgus instability in throwing athletes is typically treated with free tendon graft reconstruction as described by Jobe. Improved results could be obtained with the use of the docking technique. Uncontrolled retrospective review. The study group consisted of 36 athletes who had symptomatic insufficiency of the medial collateral ligament confirmed by magnetic resonance imaging and by surgical findings. Average follow-up was 3.3 years. Key elements of the docking technique included a muscle-splitting approach without routine transposition of the ulnar nerve, routine arthroscopic assessment, treatment of associated lesions, and docking the two ends of the tendon graft into a single humeral tunnel. Thirty-three of 36 patients (92%) returned to or exceeded their previous level of competition for at least 1 year, meeting the Conway-Jobe classification criteria of "excellent." All 22 professional or collegiate athletes returned to or exceeded their previous competition level. The docking technique allowed simplified graft tensioning and improved graft fixation.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review.

            Tears of the ulnar collateral ligament (UCL) of the elbow are common injuries in overhead athletes that may be career-ending if left untreated. The goal of this systematic review was to review all published reports of UCL reconstruction in overhead athletes, determine which techniques were associated with better outcomes, and assess the strengths and weaknesses of current data. Systematic review. A systematic review of published studies evaluating reconstruction of the UCL in overhead athletes was performed using the Ovid Medline database. All studies with a cohort of athletes who underwent UCL reconstruction with a minimum of 1 year follow-up were included, resulting in a total of 8 Level III (retrospective cohort) studies. A database compiled variables of interest, including demographic variables, surgical techniques, Conway-Jobe ratings, and percentage and type of complications. Additionally, studies were evaluated for evidence of selection, performance, detection, and exclusion biases. Demographic data were similar between studies. Overall, 83% of patients in all studies had an excellent result. There was an overall 10% complication rate, with the most common complication being postoperative ulnar neuropathy, which occurred in 6% of patients. Transition to the muscle-splitting approach was associated with better outcomes than detachment of the flexor-pronator mass, as there was only a 70% rate of excellent results and a 20% rate of postoperative ulnar neuropathy in patients treated with detachment of the flexor-pronator mass compared with 87% excellent results and a 6% rate of postoperative ulnar neuropathy in patients treated with a muscle-splitting approach. Abandoning obligatory ulnar nerve transposition was associated with better outcomes, as there was only a 75% rate of excellent results and a 9% rate of postoperative ulnar neuropathy in patients treated with obligatory ulnar nerve transposition compared with 89% excellent results and a 4% rate of postoperative ulnar neuropathy in patients who did not have obligatory ulnar nerve transposition. The docking technique was associated with better outcomes, as there was a 76% rate of excellent results and an 8% rate of ulnar neuropathy in patients treated with a figure-of-8 technique compared with 90% excellent results and a 3% rate of postoperative ulnar neuropathy in patients treated with the docking technique and 95% excellent results and a 5% rate of postoperative ulnar neuropathy in patients treated with a modified docking technique. The evolution in surgical techniques, most notably use of a muscle-splitting approach to the flexor-pronator mass, decreased handling of the ulnar nerve, and use of the docking technique, have resulted in improved outcomes and reduced complications. Although injury to the UCL was once a career-ending injury in overhead athletes, development and continued evolution of UCL reconstruction have made return to previous or higher level of athletic participation in sports highly likely. Future research should continue to utilize higher levels of evidence and compare new graft fixation techniques in an attempt to further improve the ability of overhead athletes to return to sports.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Clinical outcomes of the DANE TJ technique to treat ulnar collateral ligament insufficiency of the elbow.

              Many improvements in ulnar collateral ligament reconstruction have been made since Jobe et al first described the procedure. A novel elbow ulnar collateral ligament reconstruction technique that combines interference screw fixation on the ulna with docking of the graft on the humeral side (DANE TJ) has been reported. Outcomes of ulnar collateral ligament reconstructions performed with the DANE TJ technique are as good as other recently published results of ulnar collateral ligament reconstruction, particularly in cases of insufficient bone stock on the sublime tubercle and revision reconstructions. Case series; Level of evidence, 4. During a 3-year period, 22 athletes were treated with surgical reconstruction of the ulnar collateral ligament using proximal docking and distal interference screw fixation of the ligament (DANE TJ technique). All patients had a history, physical examination findings, and magnetic resonance imaging results consistent with ulnar collateral ligament injury. Patients were evaluated at a mean of 36 months postoperatively. Outcomes were classified using a modified Conway Scale. At the most recent follow-up, 19 of 22 patients had excellent results. There were 2 fair results and 1 poor result. The poor result was in a revision case. The 2 other revision ulnar collateral ligament reconstructions had excellent outcomes. When used in 2 cases of sublime tubercle avulsions, the results were excellent. Postoperative complications occurred in 4 patients: 2 developed ulnar neuritis, and 2 required second surgeries for lysis of adhesions. Three of these 4 patients went on to have excellent outcomes. Clinically, the initial results compare favorably with other published techniques of elbow ulnar collateral ligament reconstruction. These early data support the use of the DANE TJ technique for revision cases and cases of sublime tubercle insufficiency.
                Bookmark

                Author and article information

                Journal
                Sports Health
                Sports Health
                SPH
                spsph
                Sports Health
                SAGE Publications (Sage CA: Los Angeles, CA )
                1941-7381
                1941-0921
                July 2009
                July 2009
                : 1
                : 4
                : 301-313
                Affiliations
                []Physiotherapy Associates Scottsdale Sports Clinic, Scottsdale, Arizona
                []Champion Sports Medicine, Birmingham, Alabama
                [§ ]Hospital for Special Surgery, New York, New York
                []Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama
                Author notes
                [*] [* ]Address correspondence to Todd S. Ellenbecker, DPT, Physiotherapy Associates Scottsdale Sports Clinic, 9917 North 95th Street, Scottsdale, AZ 85258 (e-mail: ellenbeckerpt@ 123456cox.net ).
                Article
                10.1177_1941738109338553
                10.1177/1941738109338553
                3445125
                23015887
                fcdff889-2696-4714-8f6d-8c0cd527a6c7
                © 2009 The Author(s)
                History
                Categories
                Sports Physical Therapy
                3
                22
                115
                163
                Custom metadata
                July/August 2009

                Sports medicine
                baseball,elbow,throwing,rehabilitation,ulnar collateral ligament,overhead athlete
                Sports medicine
                baseball, elbow, throwing, rehabilitation, ulnar collateral ligament, overhead athlete

                Comments

                Comment on this article