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Elbow Ulnar Collateral Ligament Injury Joshua S Elbow Ulnar Collateral Ligament Injury Joshua S. Dines • David W. Altchek Editors Elbow Ulnar Collateral Ligament Injury A Guide to Diagnosis and Treatment Editors Joshua S. Dines David W. Altchek Sports Medicine and Shoulder Service Sports Medicine and Shoulder Service Hospital for Special Surgery Hospital for Special Surgery New York New York New York New York USA USA Videos to this book can be accessed at http://link.springer.com/book/10.1007/978-1-4899-7540-9. ISBN 978-1-4899-7539-3 ISBN 978-1-4899-7540-9 (eBook) DOI 10.1007/978-1-4899-7540-9 Library of Congress Control Number: 2014959417 Springer Boston Heidelberg New York Dordrecht London © Springer Science+Business Media New York 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illus- trations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are ex- empt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer US is part of Springer Science+Business Media (www.springer.com) Before Dr. Frank Jobe (1925–2014) created the “Tommy John Procedure” for Ulnar Collateral Ligament reconstruction, UCL injury was career ending. His ingenuity and surgical skill transformed this injury into a procedure commonly performed with a success rate approaching 90 %. Lewis Yocum MD (1947–2013) trained with Dr. Jobe at the Kerlan Jobe Clinic in Los Angeles. He, too, became a world- renowned sports surgeon serving as the team doctor for the LA Angels of Anaheim for 36 years. The following monograph is dedicated to both Frank Jobe MD and Lewis Yocum MD. Both were outstanding surgeons and even better people. Their dedication to treating baseball players saved the careers of thousands of players at all levels worldwide. v Foreword I can think of few textbooks more timely in the field of sports medicine than the following on elbow ulnar collateral ligament injuries. Not only has the 2014 baseball season seen an alarming increase in the number of these injuries but it was also prior to the 2014 season during which two of the forefathers of baseball medicine passed away: Dr. Frank Jobe and Dr. Lewis Yocum. I can think of no better tribute to these men than this book which features chapters written by many of their former students, fellows, and colleagues. David and Josh, the editors, have assembled all of the current thought leaders in the field to address the topic of ulnar collateral ligament (UCL) injury in a more thorough way than has been done before. Not only does the monograph cover the basics like exam and imaging of the elbow in a thorough and read- able way but it also tackles complicated topics such as revision UCL recon- struction and UCL reconstruction in high school athletes. Furthermore, there is an outstanding section on nonoperative treatment as well as postoperative rehabilitation, which will surely be of interest to surgeons and non-surgeons alike. As UCL injuries continue to be more common, I am confident that this book will find its way on to the shelves of all doctors, therapists and trainers who treat these injuries. Kerlan Jobe Orthopedic Clinic Neal S. Elattrache, MD Los Angeles CA vii Preface Since the initial description of elbow ulnar collateral ligament reconstruction by Dr. Frank Jobe, the use of the procedure to save the careers of baseball players (and other athletes) at all levels of play has increased exponentially. Over the last decade, our understanding of the biomechanics of throwing has improved, as has our ability to diagnose injuries in these athletes. Given these advances, we believed that a monograph dedicated to the diagnosis and treat- ment of injuries of the UCL would be of interest to the doctors, therapists and trainers who work with athletes that suffer these injuries. We have assembled a world-class group of authors to review the biome- chanics and pathophysiology of throwing injuries. Keys to performing a physical exam in this unique group of patients are highlighted in the text as are pearls to interpreting imaging studies. Since Dr. Jobe’s initial description of the technique that he used to recon- struct pitcher Tommy John’s ligament, several modifications have been described. All currently-used techniques are illustrated here with both pic- tures and video. Outcomes are discussed in detail as they pertain to individual reconstruction constructs as well as to particular sports. As anyone who treats these injuries knows, proper rehabilitation is critical to getting athletes back to their previous level of play. In this book, experts outline appropriate rehabilitation protocols and timelines. We hope that this monograph helps readers gain a better understanding of UCL injuries with the goal of not only improving outcomes after UCL recon- struction but also preventing these injuries. New York, NY Joshua S. Dines and David W. Altchek ix Contents 1 Clinically Relevant Elbow Anatomy and Surgical Approaches ����������������������� 1 Xinning Li and LTC Josef K. Eichinger 2 Ulnar Collateral Ligament: Throwing Biomechanics ....................................... 11 Kenneth Durham Weeks and David M. Dines 3 Valgus Extension Overload ................................................................................. 17 David C. Gerhardt and E. Lyle Cain 4 Ulnohumeral Chondral and Ligamentous Overload ........................................ 27 Sheref E. Hassan and Daryl C. Osbahr 5 Epidemiology of Elbow Ulnar Collateral Ligament Injuries ........................... 35 Lauren M. Fabian and Stan A. Conte 6 History and Physical Exam on the Thrower’s Elbow ....................................... 43 William Piwnica-Worms, Brian Grawe and Joshua S. Dines 7 Radiographic Imaging of the Elbow .................................................................. 53 Susie Muir and John V. Crues 8 MR Imaging in Patients with Ulnar Collateral Ligament Injury ................... 67 Brett Lurie, Jan Fritz and Hollis G. Potter 9 Ultrasound Imaging of Ulnar Collateral Ligament Injury .............................. 79 Michael C. Ciccotti M.D., Levon N. Nazarian M.D. and Michael G. Ciccotti M.D. 10 The Conservative Treatment of Ulnar Collateral Ligament Injuries ������������� 93 Jaicharan J. Iyengar and Christopher S. Ahmad 11 Injections Including Platelet-Rich Plasma ......................................................... 99 Michael E. Angeline, John M. Zajac, Albert O. Gee, Joshua S. Dines and David W. Altchek xi xii Contents 12 Ulnar Collateral Ligament Reconstruction: Graft Selection and Harvest Technique ������������������������������������� 107 James E� Voos 13 Primary Repair of Ulnar Collateral Ligament Injuries of the Elbow ������������������������������������������������������������������� 115 Felix H� Savoie, Michael J� O’Brien and Larry D� Field 14 The Role of Arthroscopy in Athletes with Ulnar Collateral Ligament Injuries������������������������������������������������������� 125 Curtis Bush and John E� Conway 15 Biomechanics of Reconstruction Constructs ����������������������������� 135 Miguel A� Ramirez and Anand M� Murthi 16 Figure of 8 Technique and Outcomes ����������������������������������������� 141 Tony Wanich, Jared M� Newman and Lewis A� Yocum 17 Ulnar Collateral Ligament Reconstruction: Docking Technique ����������������������������������������������������������������������� 149 Joshua S� Dines, Alexandra D� Berger and David W� Altchek 18 American Sports Medicine Institute Techniques and Outcomes ������������������������������������������������������������������������������� 155 Anthony James Scillia and Jeffrey R� Dugas 19 Ulnar Collateral Ligament Reconstruction: Alternative Surgical Techniques ������������������������������������������������� 167 Benjamin C� Service, Neal S� ElAttrache and Daryl C� Osbahr 20 Combined Flexor-Pronator Mass and Ulnar Collateral Ligament Injuries ������������������������������������������������������ 175 Alexander Christ, Joshua S� Dines, Christopher Chin and David W� Altchek 21 Ulnar Nerve Issues in Throwing Athletes ���������������������������������� 179 Albert O� Gee, Michael E� Angeline, Joshua S� Dines and David W� Altchek 22 Revision Ulnar Collateral Ligament Reconstruction ��������������� 189 Andrew J� Rosenbaum, Michael A� Flaherty, Christopher Chin, Neal S� Elattrache and Joshua S� Dines 23 Ulnar Collateral Ligament Injuries in High-School-Aged Athletes ����������������������������������������������������� 195 Lauren M� Fabian and Orr Limpisvasti Contents xiii 24 Ulnar Collateral Ligament Injury in Female Athletes ................................. 205 Elizabeth C. Gardner and Asheesh Bedi 25 Complications of Ulnar Collateral Ligament Repair ..................................
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