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American Sports Medicine Institute Techniques and Outcomes

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Elbow Ulnar Collateral Ligament Injury

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Abstract

Ulnar collateral ligament (UCL) injuries of the elbow are typically seen in overhead athletes due to the significant valgus stress on the medial structures of the elbow during throwing. Consistency between history, physical examination, and imaging studies is necessary to make the diagnosis. Patients who desire to continue competitive overhead activity and have failed conservative measures have been treated successfully with UCL reconstruction using the Andrews modification of the original Jobe technique at the American Sports Medicine Institute (ASMI). In the treatment of over 2000 athletes with UCL reconstruction, return to sport at the same or higher level can be expected 9 months to 1 year after surgery. Significant complications with this procedure are low, and failure to return to sport is typically due to factors other than the UCL reconstruction. The increasing prevalence of this procedure has been recognized especially in youth baseball players, which has led to further investigation into pitching mechanics and the prevention of these injuries.

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References

  1. Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23(2):233–9.

    Article  CAS  PubMed  Google Scholar 

  2. Werner SL, Fleisig GS, Dillman CJ, Andrews JR. Biomechanics of the elbow during baseball pitching. J Orthop Sports Phys Ther. 1993;17:274–8.

    Article  CAS  PubMed  Google Scholar 

  3. Andrews JR, Jost PW, Cain EL. The ulnar collateral ligament procedure revisited- the procedure we use. Sports Health. 2012;4:438–41.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Cain EL, Andrews JR, Dugas JR, Wilk KE, McMichael CS, Walter JC, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes. Am J Sports Med. 2010;38(12):2426–34.

    Article  PubMed  Google Scholar 

  5. Osbahr DC, Cain EL, Raines BT, Fortenbaugh D, Dugas JR, Andrews JR. Long-term outcomes after ulnar collateral ligament reconstruction in competitive baseball players- follow-up with minimum of 10 years. American Academy of Orthopaedic Surgeons Annual Meeting. 2013 March 11–15; Chicago, IL.

    Google Scholar 

  6. Azar FM, Andrews JR, Wilk KE, Groh D. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med. 2000;28:16–23.

    CAS  PubMed  Google Scholar 

  7. Dugas JR, Bilotta J, Watts CD, Crum JA, Fleisig GS, McMichael CS, et al. Ulnar collateral ligament reconstruction with gracilis tendon in athletes with intraligamentous bony excision. Am J Sports Med. 2012;20(7):1578–82.

    Article  Google Scholar 

  8. Fleisig GS, Andrews JR. Prevention of elbow injuries in youth baseball pitchers. Sports Health. 2012;1(4):314–20.

    Google Scholar 

  9. Waris W. Elbow injuries of javelin-throwers. Acta Chir Scand. 1946;93(6):563–75.

    CAS  PubMed  Google Scholar 

  10. Bennett GE. Shoulder and elbow lesions of the professional baseball pitcher. JAMA. 1941;117(7):4.

    Article  Google Scholar 

  11. King JW, Brelsford HJ, Tullos HS. Analysis of the pitching arm of the professional baseball pitcher. Clin Orthop. 1969;67:116–23.

    Article  CAS  PubMed  Google Scholar 

  12. Norwood LA, Shook JA, Andrews JR. Acute medial elbow ruptures. Am J Sports Med. 1981;9(1):16–9.

    Article  CAS  PubMed  Google Scholar 

  13. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am. 1986;68(8):1158–64.

    CAS  PubMed  Google Scholar 

  14. Yocum LA, Wanich T. Ulnar collateral ligament reconstruction. In: Dines J, Altchek DW, Andrews JR, ElAttrache NS, editors. Sports medicine of baseball. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 231–43.

    Google Scholar 

  15. Safran M, Ahmad CS, Elattrache NS. Ulnar collateral ligament of the elbow. Arthroscopy. 2005;21(11):1381–95.

    Article  PubMed  Google Scholar 

  16. Cain EL, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes-a current concepts review. Am J Sports Med. 2003;31:621–35.

    PubMed  Google Scholar 

  17. Ahmad CS, ElAttrache NS. Elbow valgus instability in throwing athlete. J Am Acad Orthop Surg. 2006;14:693–700.

    PubMed  Google Scholar 

  18. 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;10:152–7.

    Article  CAS  PubMed  Google Scholar 

  19. Savoie FH, 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.

    Article  PubMed  Google Scholar 

  20. Rohrbough JT, Altchek DW, Hyman J, Williams RJ III, Botts JD. Medial collateral ligament reconstruction of the elbow using the docking technique. Am J Sports Med. 2002;30:541–8.

    PubMed  Google Scholar 

  21. Dugas JR, Cain EL. Ulnar nerve injury in the throwing athlete. In: ElAttrache NS, Harner CD, Mirzayan R, Sekiya JK, editors. Surgical techniques in sports medicine. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 299–305.

    Google Scholar 

  22. Conway JE, Jobe FW, Glousan 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;74:67–83.

    CAS  PubMed  Google Scholar 

  23. Dugas JR, Ostrander RV, Cain EL, Kingsley D, Andrews JR. Anatomy of the anterior bundle of the ulnar collateral ligament. J Shoulder Elbow Surg. 2007;16:657–60.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Dugas JR, Bullens-Borrow A. Instability and arthroscopy. In: Johnson DL, Mair SD, editors. Clinical sports medicine. Philadelphia: Mosby Elsevier; 2006. p. 341–51.

    Chapter  Google Scholar 

  26. Wilson FD, Andrews JR, Blackburn TA, McCluskey G. Valgus extension overload in the pitching elbow. Am J Sports Med. 1983;11:83–8.

    Article  CAS  PubMed  Google Scholar 

  27. Azar FM. History and examination of the thrower’s elbow. Sports Med Arthroscopy Rev. 2003;11(1):10–4.

    Article  Google Scholar 

  28. Dugas JR, Weiland AJ. Vascular pathology in the throwing athlete. Hand Clin. 2000;16:477–85.

    CAS  PubMed  Google Scholar 

  29. Lee ML, Rosenwasser MP. Chronic elbow instability. Orthop Clin North Am. 1999;30:81–9.

    Article  CAS  PubMed  Google Scholar 

  30. Rijke AM, Goitz HT, McCue FC, Andrews JR, Berr SS. Stress radiography of the medial elbow ligaments. Radiology. 1994;19(1):213–6.

    Article  Google Scholar 

  31. Veltri DM, Field LD, Deutsch A, Altcher A, Potter H. The milking maneuver-a new test to evaluate the MCL of the elbow in the throwing athlete. J Shoulder Elbow Surg. 1995;4(1):4A.

    Google Scholar 

  32. O’Driscoll SWM, Lawton RL, Smith AM. The “moving valgus stress test” for medial collateral ligament tears of the elbow. Am J Sports Med. 2005;33(2):231–9.

    Article  PubMed  Google Scholar 

  33. Salvo JP, Rizio L, Zvijac JE, Uribe JW, Hechtman KS. Avulsion fracture of the ulnar sublime tubercle in overhead throwing athletes. Am J Sports Med. 2002;30(3):426–31.

    PubMed  Google Scholar 

  34. 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):297–9.

    Article  CAS  PubMed  Google Scholar 

  35. 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 J Sports Med. 1994;22(1)26–31.

    Article  CAS  PubMed  Google Scholar 

  36. Miller CD, Savoie FH III. Valgus extension injuries of the elbow in the throwing athlete. J Am Acad Orthop Surg. 1994;2:261–9.

    PubMed  Google Scholar 

  37. Rettig AC, Sherrill C, Snead DS, Mendler C, Mieling P. Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med. 2001;21:15–7.

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  39. Lee KS, Rosas HG, Craig JG. Musculoskeletal ultrasound: elbow imaging and procedures. Semin Musculoskelet Radiol. 2010;14(4):449–60.

    Article  PubMed  Google Scholar 

  40. Sasaki J, Takahara M, Ogino T, Kashiwa H, Ishigaki D, Kanauchi Y. Ultrasonographic assessment of the ulnar collateral ligament and medial elbow laxity in college baseball players. J Bone Joint Surg Am. 2002;84-A(4):525–31.

    PubMed  Google Scholar 

  41. 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):33–6.

    Article  CAS  PubMed  Google Scholar 

  42. Lowe JB, Maggi SP, Mackinnon SE. The position of crossing branches of the medial antebrachial cutaneous nerve during cubital tunnel surgery in humans. Plast Reconstr Surg. 2004;114(3):692–6.

    Article  PubMed  Google Scholar 

  43. Andrews JR, Heggland EJH, Fleisig GS, Zheng N. Relationship of ulnar collateral ligament strain to amount of medial olecranon osteotomy. Am J Sports Med. 2001;29:716–21.

    CAS  PubMed  Google Scholar 

  44. Levin JS, Zheng N, Dugas J, Cain EL, Andrews JR. Posterior olecranon resection and ulnar collateral ligament strain. J Shoulder Elbow Surg. 2004;13(1):66–71.

    Article  PubMed  Google Scholar 

  45. Soltani AM, Peric M, Francis CS, Nguyen TT, Chan LS, Ghiassi A, et al. The variation in the absence of the palmaris longus in a multiethnic population of the United States: an epidemiological study. Plast Surg Int. 2012;31 (Article ID 282959).

    Google Scholar 

  46. Sebastin SJ, Puhaindran ME, Lim AYT, Lim IJ, Bee WH. The prevalence of absence of the palmaris longus-a study in a Chinese population and a review of the literature. J Hand Surg Br. 2005;30(5):525–27.

    Article  CAS  PubMed  Google Scholar 

  47. Andrews JR, Timmerman LA. Outcome of elbow surgery in professional baseball players. Am J Sports Med. 1994;23:407–13.

    Article  Google Scholar 

  48. Petty DH, Andrews JR, Gleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players-clinical results and injury risk factors. Am J Sports Med. 2004;32(5):1158–64.

    Article  PubMed  Google Scholar 

  49. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34(6):905–12.

    Article  PubMed  Google Scholar 

  50. Fleisig GS, Kingsley DS, Loftice JW, Dinnen KP, Ranganathan R, Dun S, et al. Kinetic comparison among the fastball, curveball, change-up, and slider in collegiate baseball pitchers. Am J Sports Med. 2006;34(3):423–30.

    Article  PubMed  Google Scholar 

  51. Escamilla RF, Barrentine SW, Fleisig GS, Zheng N, Takada Y, Kingsley D, et al. Pitching biomechanics as a pitcher approaches muscular fatigue during a simulated baseball game. Am J Sports Med. 2007;35(1):23–33.

    Article  PubMed  Google Scholar 

  52. Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30(4):463–8.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. American Sports Medicine Institute, Orthopaedic Surgery, Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL, USA

    Anthony James Scillia MD

  2. Andrews Sports Medicine and Orthopedic Center, 805 St. Vincent’s Drive, Suite 100, 35205, Birmingham, AL, USA

    Jeffrey R. Dugas MD

Authors
  1. Anthony James Scillia MD
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  2. Jeffrey R. Dugas MD
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Corresponding author

Correspondence to Jeffrey R. Dugas MD .

Editor information

Editors and Affiliations

  1. Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA

    Joshua S. Dines

  2. Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA

    David W. Altchek

Video Legends

Video 18.1 Surgical approach and ulnar nerve transposition

Video 18.2 Anatomic tunnel preparation

Video 18.3 Graft passage and tensioning

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Scillia, A., Dugas, J. (2015). American Sports Medicine Institute Techniques and Outcomes. In: Dines, J., Altchek, D. (eds) Elbow Ulnar Collateral Ligament Injury. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7540-9_18

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  • DOI: https://doi.org/10.1007/978-1-4899-7540-9_18

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  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4899-7539-3

  • Online ISBN: 978-1-4899-7540-9

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