Elbow ulnar collateral ligament injury : a guide to diagnosis and treatment.

Foreword
Preface
Contents
Contributors
1: Anatomy and Biomechanics of the Medial Ulnar Collateral Ligament
	Introduction
	Biomechanics of Medial Ulnar Collateral Ligament Complex
		Anterior Bundle (Anterior Band, Posterior Band, and Central Band)
		Posterior Bundle
		Transverse Ligament
	Anatomy of the Medial Elbow Complex Dynamic Stabilizers
	Microanatomy and Biomechanical Properties
	Conclusion
	References
2: Clinically Relevant Elbow Anatomy and Surgical Approaches
	Pertinent Anatomy of the Thrower’s Elbow
		Osseous Anatomy
	Muscular Anatomy
		Flexor–Pronator Mass
		Palmaris Longus Tendon
	Nerve Anatomy
		Medial Antebrachial Cutaneous Nerve
		Ulnar Nerve
	Ligamentous Anatomy
		Medial Ulnar Collateral Ligament
	Relevant Surgical Approaches
		Positioning
		Elbow Arthroscopy
		Medial Approach—Muscle Splitting
		Medial Approach—Flexor–Pronator Mass Elevation
	References
3: Ulnar Collateral Ligament: Throwing Biomechanics
	Introduction
	Biomechanics of Throwing
	Six Phases of the Baseball Pitch
		Phase I
		Phase II
		Phase III
		Phase IV
		Phase V
		Phase VI
	The Kinetic Chain Theory
	Anatomy and Biomechanics of the Elbow
	Osseous Anatomy
	Vascular Anatomy
	Ligamentous Anatomy: Medial Elbow
	Musculotendinous Anatomy
	Ulnar Nerve
	Biomechanics of Medial Elbow Injury
	References
4: Monitoring the Throwing Motion: Current State of Wearables and Analytics
	Introduction
	Biomechanical Parameters of the Throwing Motion
	Traditional Methods of Motion Capture
	Motion Capture Using Wearable Technology
	Evaluation of Fatigue and Workload
	Analysis of Muscle Recruitment
	Wearable Technology in Orthopedic Literature
	Current Limitations of Wearable Technology
	Future Outlook
	References
5: Medial Ulnar Collateral Ligament Injury Prevention Strategies
	Introduction
	Youth and Adolescents
	High School and College
	Professional
	References
6: Valgus Extension Overload
	Introduction
	Anatomy and Biomechanics
	History and Physical Examination
	Imaging Studies
	Treatment
	Surgical Technique
	Postoperative Management
	Results
	Summary
	References
7: Ulnohumeral Chondral and Ligamentous Overload
	Introduction
	Functional Anatomy
	Pathophysiology and Biomechanics
	Diagnosis
		Clinical History
		Physical Examination
		Imaging
	Clinical Implications
	Treatment
	Outcomes
	Summary
	References
8: Epidemiology of Elbow Ulnar Collateral Ligament Injuries
	Introduction
	Ulnar Collateral Ligament Injuries in Other Sports
	Ulnar Collateral Ligament Injuries in Baseball
	Little League
	High School
	College
	Professional
	Conclusions
	References
9: History and Physical Exam of the Thrower’s Elbow
	Introduction
	History
	Symptom Onset and Duration
	Location of Injury
	Timing During the Throwing Motion (Fig. 9.1)
	Associated Symptoms and Previous Treatment
	Level of Competition and Timing of Play
	Physical Examination
	Observation/Inspection
	Palpation
	Neurovascular
	Range of Motion
	Manipulative Tests
	Conclusion
	References
10: Radiographic Imaging of the Elbow
	Summary
	References
11: MR Imaging in Patients with Ulnar Collateral Ligament Injury
	Introduction
	Technique
	Imaging Anatomy
	Normal Appearance of the UCL
	MR Findings in UCL Injury
		Acute Injury
		Chronic Injury
	Associated Elbow Findings in Chronic Valgus Overload
	Flexor Tendinopathy and Tears
	Ulnar Neuropathy
	Radiocapitellar Osteochondral Defects
	Apophyseal Injury
	Postsurgical Elbow
	Conclusion
	References
12: Ultrasound Imaging of Ulnar Collateral Ligament Injury
	Introduction
	Science of Ultrasonography
	Ultrasound for the Evaluation of the UCL
	Review of Stress Ultrasound and the UCL: A 15+ Year Experience
	Algorithm Utilizing Ultrasound for UCL Injury
	Case Examples
		Acute, Partial UCL Tear
		Failure of Nonoperative Treatment for UCL Tear
		Revision UCL with Post-op Pain Secondary to Kinetic Chain Deficits
	Summary
	References
13: The Conservative Treatment of Ulnar Collateral Ligament Injuries
	Introduction
	Clinical History
	Physical Examination
	Imaging
	Treatment Options
		Injection Treatments
	Principles of Rehabilitation
	Thrower’s Assessment
	Progressive Throwing Program
	Injury Prevention
		Pitch Counts and Off-Days
		Sport Diversification
		Education
	Seasonal Timing Considerations
	Outcomes
	Conclusions
	References
14: The Role of Biologics in Ulnar Collateral Ligament Injuries
	Introduction
	Management Decision-Making
	Biologic Augmentation
	Our Preferred Treatment Algorithm
	Conclusion
	References
15: Evolution of Surgical Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow
	Introduction
	MUCL Reconstruction Techniques – Figure of Eight Constructs (Fig. 15.2)
		Jobe Technique (1986)
		American Sports Medicine Institute (ASMI) Technique (1995)
		Modified Jobe Technique (2001)
		Docking Plus Technique (2012)
	MUCL Reconstruction Techniques – Triangular Constructs (Fig. 15.3)
		Docking Technique (2002)
		Three- and Four-Strand Docking Techniques (2006)
		Hechtman’s Hybrid Technique (1998)
	MUCL Reconstruction Techniques – Linear Constructs (Fig. 15.4)
		Dual Interference Screw Technique (2003)
		David Altcheck and Neal ElAttrache Tommy John (DANE TJ) Technique (2006)
		EndoButton Technique (2005)
		Double Docking Technique (2007)
		GraftLink and TightRope Techniques (2013)
		Anatomic Technique (2019)
	Conclusion
	References
16: Ulnar Collateral Ligament Reconstruction: Graft Selection and Harvest Technique
	Introduction
	Graft Selection Options
	Graft Harvesting Techniques
		Palmaris Longus Tendon
		Gracilis or Semitendinosus Tendon
	Complications
	Conclusion
	References
17: Primary Repair of Ulnar Collateral Ligament Injuries of the Elbow
	Introduction
		History
		Evolution of Repair
		Indications and Rationale for Repair
	Tulane-MSMOC Protocol
	Surgical Technique
	Post-op Rehabilitation
	Return to Play
	Functional Outcome
	Reoperation
	Complications
	Discussion
	Conclusion
	References
18: Repair and Internal Brace Augmentation of the Medial Ulnar Collateral Ligament
	Introduction
	Biomechanics
	UCL Repair Indications
	Surgical Technique
	Outcomes
	Conclusion
	References
19: The Role of Arthroscopy in Athletes with Ulnar Collateral Ligament Injuries
	Introduction
	Diagnostic Arthroscopy
	Posterior Impingement
	Posterolateral Impingement
	Posteromedial Impingement
	Direct Posterior Impingement
	Trochlear Chondromalacia
	Olecranon Exostosis and Fragmentation
	Loose Bodies
	Capitellar Osteochondritis Dissecans
	Surgical Technique
	Rehabilitation Considerations
	Conclusion
	References
20: Biomechanics of Reconstruction Constructs
	Introduction
	Jobe Technique
	Docking Technique
	Suture Anchor Technique
	Interference Screw Technique
		High-Strength Suture Tape Augmentation
		Other Novel Techniques
		Anatomic Considerations
	Conclusions
	References
21: Figure of 8 Technique and Outcomes
	Introduction
	Modified Jobe Technique
	American Sports Medicine Institute (ASMI) Modification
	Postoperative Rehabilitation
	Outcomes
	References
22: Ulnar Collateral Ligament Reconstruction: Docking Technique
	Introduction
	Preoperative Considerations
		History
		Physical Examination
		Imaging
		Indications and Contraindications
	Surgical Technique
		Anesthesia and Positioning
		Surgical Landmarks/Incisions
		Postoperative Protocol
	Results
	References
23: Ulnar Collateral Ligament Reconstruction: American Sports Medicine Institute Technique and Outcomes
	Introduction
	Clinical Evaluation
		History
		Physical Examination
		Imaging
	Treatment
		Conservative
		Operative
	Rehabilitation
	Outcomes
	Prevention
	Complications
		Revision UCL Reconstruction
		UCL Repair with Internal Brace Augmentation
	Conclusion
	References
24: Ulnar Collateral Ligament Reconstruction: Alternative Surgical Techniques
	Introduction
	UCL Reconstruction: Biomechanical Assessment
	Surgical Approach
	Surgical Technique: DANE TJ UCL Reconstruction
	Surgical Technique: Cortical Suspensory UCL Reconstruction [8]
	Surgical Technique: Anatomic UCL Reconstruction [15]
	Surgical Closure and Postoperative Care
	Discussion
	DANE TJ UCL Reconstruction
	Cortical Suspensory UCL Reconstruction
	Anatomic UCL Reconstruction
	Conclusion
	References
25: Combined Flexor-Pronator Mass and Ulnar Collateral Ligament Injuries
	Introduction
	Diagnosis
	Operative Treatment
	Rehabilitation
	Outcomes and Complications
	References
26: Ulnar Nerve Issues in Throwing Athletes
	Introduction
	History
	Surgical Modifications
	The Hospital for Special Surgery (HSS) Technique
	American Sports Medicine Institute (ASMI) Technique
	Ulnar Nerve Dysfunction in Throwing Athletes
	Ulnar Nerve Anatomy and Sites of Compression
	Evaluation of the Ulnar Nerve in the Throwing Elbow
	Treatment
	Authors’ Preferred Technique for Ulnar Nerve Transposition
	Conclusion
	References
27: Revision Ulnar Collateral Ligament Reconstruction
	Introduction
	Suboptimal Outcomes and Complications After Primary Reconstruction
	Indications for Revision Surgery for Failed UCL Reconstruction
	Preoperative Evaluation and Considerations for UCL Reconstruction
	Principles of Revision Surgery for Failed UCL Reconstruction
	Ulnar Bone Loss
	Humeral Bone Loss
	Outcomes Following Revision Surgery for Failed UCL Reconstruction
	Summary
	References
28: Medial Ulnar Collateral Ligament Injuries in Baseball Position Players
	Introduction
	Pathoanatomy and Epidemiology
	Presentation and Evaluation
	Treatment
	Postoperative Rehabilitation Protocol
	Outcomes of UCLR in Position Players
	Conclusion
	References
29: Management of UCL Injuries in Non-throwing Athletes
	Introduction
	Epidemiology
	Mechanism of Injury
	Treatment Outcomes
		Non-operative Management
		Operative Management with UCL Reconstruction
		Operative Management with UCL Repair
	Preferred Algorithm
	Conclusions
	References
30: Ulnar Collateral Ligament Injury in Female Athletes
	Introduction
	Epidemiology and Pathoanatomy
	Biomechanics of UCL Injury in Women
	Presentation and Evaluation
	Indications and Procedures
	Rehabilitation
	Conclusion
	References
31: Ulnar Collateral Ligament Injuries in High-School-Aged Athletes
	Background
	Anatomy and Physiology
	Risk Factors/Prevention
	Evaluation
		History
		Physical Examination
		Imaging
	Treatment
		Conservative Management
		Operative Intervention
		Rehabilitation
	Summary
	References
32: Medial Apophysitis in Adolescent Throwers
	Introduction
	Pathogenesis
	Presentation
	Diagnosis
	Prevention
	Treatment
	References
33: Complications of Ulnar Collateral Ligament Reconstruction
	Introduction
	Complications Related to Surgical Variables
	Nerve Injury
	Infection
	Motion Loss and Arthrofibrosis
	Reconstruction Construct Failure
	Complications Related to Graft Harvest Site
	Complications Related to Posteromedial Impingement
	Medial Epicondyle Fractures
	Other Complications
	Summary
	References
34: Sport-Specific Outcomes for Ulnar Collateral Ligament Reconstruction
	Introduction
	Baseball
	Additional Sports
	Javelin Throwers
	Football Quarterbacks
	Softball Pitchers
	Other Sports
	Conclusion
	References
35: Rehabilitation of the Overhead Athlete’s Elbow
	Introduction
	General Rehabilitation Guidelines
	Phase I: Immediate Motion Phase
	Phase II: Intermediate Phase
	Phase III: Advanced Strengthening Phase
	Phase IV: Return to Activity Phase
	Specific Nonoperative Rehabilitation Guidelines
		Ulnar Collateral Ligament Injury
		Medial Epicondylitis and Flexor-Pronator Tendinitis
		Ulnar Neuropathy
		Valgus Extension Overload
		Osteochondritis Dissecans
		Little League Elbow
		Prevention of Elbow Injuries in Youth Baseball Players
	Specific Postoperative Rehabilitation Guidelines
		Ulnar Collateral Ligament Reconstruction
		Rehabilitation Comparison Between UCL Repair with Internal Brace and UCL Reconstruction
		Ulnar Nerve Transposition
		Posterior Olecranon Osteophyte Excision
	Conclusion
	References
36: Sport-Specific Rehabilitation After Ulnar Collateral Ligament Surgery
	Introduction
	Sport-Specific Concept
	Kinetic Chain Rehabilitation
	Proximal Upper Extremity Focus
	Core and Hip Stabilization of the Overhead Athlete
	Glenohumeral Joint Range of Motion
	Functional Activity Progressions (Plyometrics)
	Throwing Progressions Following UCL Reconstruction
	Batting Progressions Following UCL Reconstruction
	Golf Progression Following UCL Reconstruction
	Tennis Progression Following UCL Reconstruction
	Emphasis on Proper Mechanics
	Summary
	References
Index