Summary

Reconstruction of the Medial Collateral Ligament of the Elbow, Clinical Outcomes in Elite Weightlifters

Abstract

Introduction

Valgus instability is commonly observed in weightlifters due to overuse injury or acute trauma-elbow dislocation. Chronic valgus stress usually results in ruptured anterior band of the medial collateral ligament (MLC) Overtime the athlete may experience elbow pain, compromise in sports performance and instability. Elite weightlifters are susceptible to this type of injury due to chronic repetitive microtrauma and, not rarely, undiagnosed elbow (micro)instability.

Aim

The purpose of this study was to assess the clinical outcomes and return to sport rate in elite weightlifters who underwent medial collateral ligament reconstruction using free tendon autografts.

Methods

Elite weightlifters who were candidates for the Greek national team and who had won national and international medals were included. Non – professional weightlifters were excluded from the analysis. All patients underwent reconstruction of the medial collateral ligament of the elbow by a single surgeon using autograft tissue. Clinical examinations and Magnetic Resonance Imaging (MRI) and/or elbow arthroscopy were used to make the diagnosis. Data collected were patient demographics (age, gender), lever of competition, pre-operative diagnosis and type of autograft used to reconstruct the ligament. The clinical outcome was assessed by recording and comparing the Mayo Elbow performance score pre-operatively and at a minimum 2-year follow-up after surgery. At follow-up, we also recorded the return to sports rate, patient satisfaction rate with outcome as well as complication rate.

Results

Twelve weightlifters (11 males, 1 female) met the inclusion criteria. The mean patient age was 27 years (range: 17-33). There were 3 acute MCL ruptures (elbow dislocation during performance) and 9 patients had chronic MCL insufficiency affecting their performance. Six athletes underwent elbow arthroscopy before the open MCL reconstruction to confirm the diagnosis of MCL insufficiency. The Jobe technique was applied in all patients to reconstruct the MCL. Eight patients received palmaris longus tend on autograft, 3 patients received semitendinosus tendon autograft and 1 patient had half width semitendinosus tendon autograft. The mean follow-up time was 4.5 years (range:2.2-8 years). The mean Mayo Elbow Score improved from 71 (range: 60-76) pre-operatively to 93 (range: 88-96) after surgery indicating excellent clinical outcomes. All patients returned to high level weightlifting at a mean time of 9 months (range: 6-12 months). The mean patient satisfaction rate was 10 (range 1- 10). No complications were encountered except for transient ulnar neuropathy in one patient. One athlete became European gold medalist 12 months after the procedure.

Conclusions

MCL reconstruction can successfully treat professional weightlifters with acutely torn MCL or chronic partial MCL tear of the elbow. Excellent clinical outcomes, 100% return to sport rate and high patient satisfaction with the out come were observed in these athletes at 4.5 years mean follow-up time.