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Mini-Incision Medial Collateral Ligament Reconstruction of the Elbow

  • Christopher C. Dodson
  • Steven J. Thornton
  • David W. Altchek
Chapter

Abstract

The anterior bundle of the medial collateral ligament (MCL) of the elbow is the primary restraint to valgus load. It has been well documented that throwing athletes are prone to injury of this structure secondary to the repetitive valgus loads subjected to the elbow with overhead pitching.14 Originally described in javelin throwers,5 this injury is almost exclusively seen in overhead-throwing athletes, with baseball pitchers being the most prevalent group of patients. Injury to the MCL has also been shown in wrestlers, tennis players, professional football players, and arm wrestlers.1,57 Symptomatic valgus instability can arise in these athletes after a MCL injury, thus necessitating operative intervention. Although injury to the MCL in the nonthrowing athlete can have excellent results with nonoperative intervention,8, 9 the overhead throwing athlete may find an injury to the MCL of the elbow to be a career-ending event if surgical intervention is not employed.

Keywords

Ulnar Nerve Medial Collateral Ligament Medial Epicondyle Flexor Carpus Ulnaris Medial Collateral Ligament Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    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.PubMedGoogle Scholar
  2. 2.
    Hamilton CD, Glousman RE, Jobe FW, Brault J, Pink M, Perry J. Dynamic stability of the elbow: electromyographic analysis of the flexor pronator group and the extensor group in pitchers with valgus instability. J Shoulder Elbow Surg 1996; 5(5): 347–354.CrossRefPubMedGoogle Scholar
  3. 3.
    Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am 1986; 68(8): 1158–1163.PubMedGoogle Scholar
  4. 4.
    Tullos HS, Erwin WD, Woods GW, Wukasch DC, Cooley DA, King JW. Unusual lesions of the pitching arm. Clin Orthop 1972; 88: 169–182.CrossRefPubMedGoogle Scholar
  5. 5.
    Waris W. Elbow injuries of javelin-throwers. Acta Chir Scand 1946; 93: 563–575.PubMedGoogle Scholar
  6. 6.
    Kenter K, Behr CT, Warren RF, O’Brien SJ, Barnes R. Acute elbow injuries in the National Football League. J Shoulder Elbow Surg 2000; (9): 1–5.Google Scholar
  7. 7.
    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 Elbow Surg 2001; 10(2): 152–157.CrossRefPubMedGoogle Scholar
  8. 8.
    Josefsson O, Gentz CF, Johnell O, et al. Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint. J Bone Joint Surg Am 1987; 69: 605–608.PubMedGoogle Scholar
  9. 9.
    Miller CD, Savoie FH, III. Valgus Extension Injuries of the Elbow in the Throwing Athlete. J Am Acad Orthop Surg 1994; 2(5): 261–269.PubMedGoogle Scholar
  10. 10.
    Callaway GH, Field LD, Deng XH, Torzilli PA, O’Brien SJ, Altchek DW, et al. Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone Joint Surg Am 1997; 79(8): 1223–1231.PubMedGoogle Scholar
  11. 11.
    Hotchkiss RN, Weiland AJ. Valgus stability of the elbow. J Orthop Res 1987; 5(3): 372–377.CrossRefPubMedGoogle Scholar
  12. 12.
    Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med 1983; 11(5): 315–319.CrossRefPubMedGoogle Scholar
  13. 13.
    Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary restraints. Clin Orthop 1991; 265: 187–195.PubMedGoogle Scholar
  14. 14.
    Regan WD, Korinek SL, Morrey BF, An KN. Biomechanical study of ligaments around the elbow joint. Clin Orthop 1991; 271: 170–179.PubMedGoogle Scholar
  15. 15.
    Sojbjerg JO, Ovesen J, Nielsen S. Experimental elbow instability after transaction of the medial collateral ligament. Clin Orthop 1987; 218: 186–190.PubMedGoogle Scholar
  16. 16.
    Andrews JR, Whiteside JA. Common elbow problems in the athlete. J Orthop Sports Phys Ther 1993; 17(6): 289–295.PubMedGoogle Scholar
  17. 17.
    Glousman RE, Barron J, Jobe FW, Perry J, Pink M. An electromyographic analysis of the elbow in normal and injured pitchers with medial collateral ligament insufficiency. Am J Sports Med 1992; 20(3): 311–317.CrossRefPubMedGoogle Scholar
  18. 18.
    Timmerman LA, Schwartz ML, Andrews JR. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation. Am Sports Med 1983; 11(2): 83–88.CrossRefGoogle Scholar
  19. 19.
    Wilson FD, Andrews JR, Blackburn TA, McCluskey G. Valgus extension overload in the pitching elbow. Am J Sports Med 1983; 11(2): 83–88.CrossRefPubMedGoogle Scholar
  20. 20.
    Fuss FK. The ulnar collateral ligament of the human elbow joint. Anatomy, function, and biomechanics. J Anat 1991; 175: 203–212.PubMedGoogle Scholar
  21. 21.
    Morrey BF, An KN. Functional anatomy of the ligaments of the elbow. Clin Orthop 1985; 201: 84–90.PubMedGoogle Scholar
  22. 22.
    O’Driscoll SW, Jaloszynski R, Morrey BF, An KN. Origin of the medial ulnar collateral ligament. J Hand Surg Am 1992; 17(1): 164–168.CrossRefPubMedGoogle Scholar
  23. 23.
    Timmerman LA, Andrews JR. Undersurface tear of the ulnar collateral ligament in baseball players. A newly recognized lesion. Am J Sports Med 1994; 22(1): 33–36.CrossRefPubMedGoogle Scholar
  24. 24.
    Schwab GH, Bennett JB, Woods GW, Tullos HS. Biomechanics of elbow instability: the role of the medial collateral ligament. Clin Orthop 1980; 146: 42–52.PubMedGoogle Scholar
  25. 25.
    Field LD, Callaway GH, O’Brien SJ, Altchek DW. Arthroscopic assessment of the medial collateral ligament complex of the elbow. Am J Sports Med 1995; 23(4): 396–400.CrossRefPubMedGoogle Scholar
  26. 26.
    Davidson PA, Pink M, Perry J, Jobe FW. Functional anatomy of the flexor pronator muscle group in relation to the medial collateral ligament of the elbow. Am J Sports Med 1995; 23(2): 245–250.CrossRefPubMedGoogle Scholar
  27. 27.
    O’Driscoll SW, Lawton RL, Smith AM. The “Moving Valgus Stress Test” for medial collateral ligament tears of the elbow. Am J Sports Med 2005; 33(2): 231–239.CrossRefPubMedGoogle Scholar
  28. 28.
    Ellenbecker TS, Mattalino AJ, Elam EA, Caplinger RA. Medial elbow joint laxity in professional baseball pitchers. A bilateral comparison using stress radiography. Am J Sports Med 1998; 26(3): 420–424.PubMedGoogle Scholar
  29. 29.
    Rijke AM, Goitz HT, McCue FC, Andrews JR, Berr SS. Stress radiography of the medial elbow ligaments. Radiology 1994; 191(1): 213–216.PubMedGoogle Scholar
  30. 30.
    Schwartz ML, Al Zahrani S, Morwessel RM, Andrews JR. Ulnar collateral ligament injury in the throwing athlete: evaluation with saline-enhanced MR arthrography. Radiology 1995; 197(1): 297–299.PubMedGoogle Scholar
  31. 31.
    Gaary EA, Potter HG, Altchek DW. Medial elbow pain in the throwing athlete: MR imaging evaluation. Am J Roentgenol 1997; 168(3): 795–800.Google Scholar
  32. 32.
    Potter HG. Imaging of posttraumatic and soft tissue dysfunction of the elbow. Clin Orthop 2000; 370: 9–18.CrossRefPubMedGoogle Scholar
  33. 33.
    Rohrbough JT, Altchek DW, Hyman J, et al. Medial collateral ligament reconstruction of the elbow using the docking technique. Am J Sports Med 2002; 30(4): 541–548.PubMedGoogle Scholar
  34. 34.
    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): 575–580.CrossRefPubMedGoogle Scholar
  35. 35.
    Azar FM, Andrews JR, Wilk KE, et al. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med 2000; 28: 16–23.PubMedGoogle Scholar
  36. 36.
    Elattrache NS, Bast SC, Tal D. Medial collateral ligament reconstruction. Tech Shoulder Elbow Surg 2001; 2(1): 38–49.CrossRefGoogle Scholar
  37. 37.
    Dodson CC, Thomas A, Dines JS et al. Medial collateral ligament reconstruction of the elbow in throwing athletes. Am J Sports Med 2006; 34: 1926–1932.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Christopher C. Dodson
    • 1
  • Steven J. Thornton
    • 1
  • David W. Altchek
    • 1
  1. 1.Sports Medicine and Shoulder ServiceHospital for Special SurgeryNew YorkUSA

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