2015 ISAKOS Biennial Congress Paper #0

Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction With Internal Brace Augmentation Versus Modified Docking Technique

Anthony A. Romeo, MD, Burr Ridge, IL UNITED STATES
Brandon Erickson, MD, New York, NY UNITED STATES
Sarah J Mcclish, BS, Naples, FL UNITED STATES
Coen Abel Wijdicks, PhD, Naples, Florida UNITED STATES

Rothman, New York, NY, UNITED STATES

FDA Status Not Applicable

Summary: Tape augmentation to the modified UCLR (DDA group) improved cyclic stiffness and reduced gap formation compared to the modified docking (MD) group.

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Abstract:

Background

Ulnar collateral ligament (UCL) reconstruction (UCLR) is a common surgery among baseball pitchers. UCL repair combined with augmentation using high strength tape, referred to as an internal brace, was developed as an alternative to UCLR in select patients with the benefit of allowing these athletes to return to sport (RTS) faster. A combined UCLR with an internal brace may allow players indicated for an UCLR to RTS more expeditiously.

Methods

24 cadaveric elbows were divided into 3 groups: 12 specimens into the modified docking (MD) group, 6 into the double docking (DD) group and 6 into the double docking with internal brace augmentation (DDA) group. This allowed a 1:1 comparison of the MD to the DD and the MD to the DDA. Valgus cyclic testing of native and reconstructed specimens was executed at 90° elbow flexion. After preconditioning, all specimens were cycled between 2 Nm and 10 Nm for 250 cycles. Reconstructed specimens continued to a torque test to catastrophic failure step. Outcome data included intra-cyclic stiffness, maximum cyclic rotational displacement, gap formation, and failure torque.

Results

Cyclic stiffness of the constructs remained constant throughout the entirety of the torque-controlled cycling phase. DDA group resulted in a 38% increase in cyclic stiffness from native testing (not statistically significant), and a statistically significant 54% increase from the MD (p=0.002). The DDA mean cyclic stiffness was significantly greater than Native (p<0.001), DD (p=0.025), and MD (p<0.001) groups. Between reconstruction groups, mean gap formation was greatest amongst the MD group (2.51 deg ± 1.59 deg) and least for the DDA group (1.01 deg ± 0.57 deg) but did not reach statistical significance.

Conclusion

Tape augmentation to the modified UCLR (DDA group) improved cyclic stiffness and reduced gap formation compared to the modified docking (MD) group.