Ulnar Collateral Ligament Reconstruction: A Systematic Review

@article{Purcell2007UlnarCL,
  title={Ulnar Collateral Ligament Reconstruction: A Systematic Review},
  author={Derek B. Purcell and Matthew J. Matava and Rick W Wright},
  journal={Clinical Orthopaedics and Related Research},
  year={2007},
  volume={455},
  pages={72-77}
}
Injury to the ulnar collateral ligament of the elbow is a commonly recognized lesion in the overhead throwing athlete. The techniques for reconstruction of this critical ligament have evolved over time. The outcomes of ulnar collateral ligament reconstruction were assessed for success. We systematically reviewed the literature and found five Level III retrospective cohort studies that reported outcomes after reconstruction. One study reflected shorter term followup on a cohort that was included… 
The Outcome of Elbow Ulnar Collateral Ligament Reconstruction in Overhead Athletes
TLDR
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.
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TLDR
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TLDR
Unar collateral ligament reconstruction utilizing the docking technique results in a significantly higher rate of return to play and a lower complication rate when compared with the Jobe and modified Jobe techniques.
Ulnar Nerve Complications After Ulnar Collateral Ligament Reconstruction of the Elbow: A Systematic Review
TLDR
A review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications, and it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative Ulnar neuropathy due to limitations in the current body of published literature.
Comparison of Surgical Techniques for Ulnar Collateral Ligament Reconstruction in Overhead Athletes
TLDR
Several surgical techniques and modifications for ulnar collateral ligament (UCL) reconstruction have been proposed since this procedure was first performed in 1974, but a clear, concise surgical algorithm for UCL reconstruction is lacking.
Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes
TLDR
This classic examines the landmark publication ‘Reconstruction of the Ulnar Collateral Ligament in Athletes’ by Jobe et al, published in 1986 and describes the surgical technique for UCL reconstruction and the postoperative rehabilitation and outcomes in 16 throwing athletes, including Major League Baseball pitcher Tommy John.
Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years
TLDR
Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes, and may be informative for elbow surgeons who wish to avoid autografted morbidity in common laborers and nonelites athletes with MUCL incompetency.
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References

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  • Medicine
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TLDR
Reconstruction of the ulnar collateral ligament using a free tendon graft was performed on sixteen athletes who participated in sports that involved throwing, and all had valgus instability of the elbow.
Medial Collateral Ligament Reconstruction of the Elbow using the Docking Technique *
TLDR
The docking technique allowed simplified graft tensioning and improved graft fixation and returned to or exceeded their previous level of competition for at least 1 year.
Ulnar collateral ligament reconstruction in athletes: muscle-splitting approach without transposition of the ulnar nerve.
TLDR
Surgical modifications to the ulnar collateral ligament reconstruction yielded a decreased postoperative complication rate and improved outcomes compared with the results of prior procedures, including reoperations for nerve dysfunction and no permanent nerve problems.
Operative Treatment of Ulnar Collateral Ligament Injuries of the Elbow in Athletes
TLDR
Reconstruction of the ulnar collateral ligament, with transposition and stabilization of the Ulnar nerve and appropriate rehabilitation, was found to be effective in correcting medial instability of the elbow and allowed most athletes to return to previous levels of play in less than 1 year.
Valgus Extension Injuries of the Elbow in the Throwing Athlete
TLDR
In patients who remain symptomatic after an initial course of nonoperative treatment, arthroscopy of the elbow can address many of the later changes, including chondromalacia, osteochondritis, and osteophyte formation.
A Muscle-Splitting Approach to the Ulnar Collateral Ligament of the Elbow
TLDR
It is believed that a less traumatic muscle-splitting approach to the ulnar collateral ligament affords a safe and simple surgical approach for repair or reconstruction of the ligament.
Biomechanical Evaluation of a New Ulnar Collateral Ligament Reconstruction Technique with Interference Screw Fixation *
TLDR
This technique returns elbow kinematics to near normal, with less soft tissue dissection and risk of ulnar nerve injury and ease of graft insertion, tensioning, and fixation.
Undersurface Tear of the Ulnar Collateral Ligament in Baseball Players
TLDR
A tear of the deep layer of the ulnar collateral ligament can result in symptomatic instability that is difficult to diagnose with conventional preoperative testing and was as sociated with persistent medial elbow pain in throwing athletes.
Ulnar collateral ligament injury in baseball pitchers: MR imaging evaluation.
TLDR
MR imaging findings in UCL injury included laxity, irregularity, poor definition, and increased signal intensity within and adjacent to the UCL due to repeated microtears, which eventually lead to weakening and possible disruption of theUCL.
Outcome of Elbow Surgery in Professional Baseball Players
TLDR
The patients with posteromedial olecranon osteophytes had the highest rate of reoperation, and patients who underwent ulnar collateral ligament reconstruction had a higher rate of return to play.
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