2017 ISAKOS Biennial Congress ePoster #408

 

Elbow Valgus Laxity After Ulnar Collateral Ligament Reconstruction in Competitive Athletes

Kunimoto Fukunishi, MD, Takatsuki, Osaka JAPAN
Teruhisa Mihata, MD, PhD, Takatsuki, Osaka JAPAN
Akihiko Hasegawa, MD, PhD, Takatsuki, Osaka JAPAN
Mutsumi Ohue, MD, Takatsuki JAPAN
Masashi Neo, MD, PhD, Prof., Takatsuki, Osaka JAPAN

Osaka Medical College, Takatsuki, Osaka, JAPAN

FDA Status Not Applicable

Summary

Elbow valgus laxity restored to the intact level after UCLR. The restored elbow valgus stability after UCLR has been kept until return to sports

Abstract

Background

Ulnar collateral ligament reconstruction (UCLR) has afforded overhead athletes high rate of return to previous level of play. Although biomechanical study using cadaveric elbows showed UCLR restored valgus laxity to the native state, no clinical study investigated if the restored valgus stability has been kept at the time to play competitively. The objective of this study was to evaluate elbow valgus laxity using stress ultrasound before and after UCLR, and after return to play at the previous level.

Materials And Methods

Eleven competitive athletes (mean age of 18.3 years; range, 15–22) who had undergone UCLR using the modified Jobe technique (figure-of-8 graft with a muscle-splitting approach) participated in this study. Of the 11 patients, there were 8 baseball players, 2 cheerleaders, and one wrestler. Physical examination, MRI, and stress ultrasound were performed before surgery and at 2 and 12 months after surgery. Outcomes were classified using a Conway scale. For the assessment of elbow valgus laxity, the width of the medial joint space was measured using ultrasound. The degree of elbow valgus laxity was defined as the difference in width of the medial joint space with and without valgus stress. Graft healing was assessed using ultrasound and MRI.

Results

Valgus laxity in affected elbow (1.7±0.8mm) is significantly larger than that in unaffected elbow (0.4±0.2mm) before surgery (p<0.001). After UCLR, valgus laxity in affected elbow significantly decreased to 0.1±0.1mm and 0.2±0.1mm, at 2 (p<0.001) and 12 months (p<0.001), respectively. Ultrasound and MRI showed no graft tear at 12 months after UCLR in all patients. Seven baseball players returned to competition at 11 months (8-12 months) after UCLR, 2 cheerleaders at 5 months, and a wrestler at 4 months. Ten patients (91%) had excellent outcome in Conway scale. One patient did not return to baseball for family reasons.

Conclusions

Elbow valgus laxity restored to the intact level after UCLR. The restored elbow valgus stability after UCLR has been kept until return to sports.