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James R Andrews - One of the best experts on this subject based on the ideXlab platform.

  • ulnar Collateral Ligament injuries in the throwing athlete
    Journal of The American Academy of Orthopaedic Surgeons, 2014
    Co-Authors: Jeremy Bruce, James R Andrews
    Abstract:

    : Repetitive valgus forces on the throwing elbow place significant stress on that joint. This stress can cause structural damage and injury to the ulnar Collateral Ligament. Many acute injuries of the throwing elbow are caused by repetitive chronic wear. Although much work has been done on injury prevention in youth who are pitchers, overuse injury in throwing sports constitutes an epidemic. Failing nonsurgical management, ulnar Collateral Ligament reconstruction is a viable option to return the throwing athlete to competition.

  • anatomy of the anterior bundle of the ulnar Collateral Ligament
    Journal of Shoulder and Elbow Surgery, 2007
    Co-Authors: Jeffrey R Dugas, Roger V Ostrander, David Kingsley, Lyle E Cain, James R Andrews
    Abstract:

    The purpose of this project was to study the anatomy of the anterior bundle of the ulnar Collateral Ligament and provide anatomic measurements not previously described. Thirteen fresh-frozen cadaver elbows were dissected. A 3-dimensional, electromagnetic, digitizing device was used to measure several anatomic parameters of the anterior bundle of the ulnar Collateral Ligament. The width of the Ligament was not uniform, increasing distally toward the insertion. The average area of the origin was 45.5 mm 2 , and the average area of the insertion was 127.8 mm 2 . The edge of the insertion was separated from the ulna articular margin by an average of 2.8 mm. The study provides quantitative data describing the anatomy of the anterior bundle of the ulnar Collateral Ligament. This information may prove useful in surgical techniques designed to reproduce the anatomy and biomechanics of the elbow after injury.

  • Posterior olecranon resection and ulnar Collateral Ligament strain.
    Journal of Shoulder and Elbow Surgery, 2004
    Co-Authors: Jared S Levin, Nigel Zheng, E. Lyle Cain, Jeffrey R Dugas, James R Andrews
    Abstract:

    Valgus extension overload is well described in the throwing athlete. The surgical treatment involves posterior olecranon osteophyte resection. It is not known how much of the posterior olecranon can be resected before increased stress is placed on the ulnar Collateral Ligament. Ten cadaveric arms underwent posterior olecranon resection in 4-mm increments. After each bone resection, three different valgus loads were applied to the elbow at 70° and 90° of flexion. Ulnar Collateral Ligament strain significantly increased with each load. Significantly more strain occurred on the ulnar Collateral Ligament at 90° compared with 70° of elbow flexion. This difference may be the result of the relative importance of the ulnar Collateral Ligament and the posterior olecranon at different positions of elbow flexion. The strain on the ulnar Collateral Ligament was slightly higher after the 8-mm and 12-mm cuts but not statistically significant. This study suggests that at moderate quasistatic valgus loads, ulnar Collateral Ligament strain is not significantly increased with posterior olecranon resection.

  • Relationship of Ulnar Collateral Ligament Strain to Amount of Medial Olecranon Osteotomy
    American Journal of Sports Medicine, 2001
    Co-Authors: James R Andrews, Erik J. H. Heggland, Glenn S Fleisig, Nigel Zheng
    Abstract:

    Athletes at risk for valgus extension overload are also at risk for tears of the anterior bundle of the ulnar Collateral Ligament. Some athletes develop Ligament tears after procedures for valgus extension overload such as posteromedial olecranon osteotomy. The amount of posteromedial olecranon that can be resected before ulnar Collateral Ligament strain, and risk of injury, increases is unknown. We dissected and mounted five fresh-frozen human cadaveric elbows to allow strain gauge monitoring of the ulnar Collateral Ligament with varying valgus stress, elbow flexion angle, and medial osteotomy. The average strain to failure was 11.96% ± 6.51%, corresponding to a load of 347.71 ± 46.42 N. The maximum tensile force recorded at failure was 416.24 N. Three-way repeated-measures analysis of variance revealed no significant change in strain with change in the amount of osteotomy for a given applied load and angle of flexion. On the basis of these data, we conclude that the effect of medial olecranon osteotomy ...

  • histology and arthroscopic anatomy of the ulnar Collateral Ligament of the elbow
    American Journal of Sports Medicine, 1994
    Co-Authors: Laura A Timmerman, James R Andrews
    Abstract:

    The histology and arthroscopic anatomy of the ulnar Collateral Ligament of the elbow were studied in cadav eric specimens. The capsule consists of two layers of collagen fibers, with two distinct Ligamentous bundles corresponding to anterior and posterior portions of the ulnar Collateral Ligament. The posterior bundle consists of distinct collagen bundles within the layers of the cap sule ; the anterior bundle consists of a similar thickening within the capsular layers, with an additional Ligament complex superficial to the capsular layers. With arthros copy only the anterior 20% to 30% of the anterior bundle of the ulnar Collateral Ligament could be visualized via the anterior portal. Only the posterior 30% to 50% of the posterior bundle could be seen via the posterior portals. After sectioning of the anterior bundle, joint instability was noted arthroscopically by an increased opening in the ulnohumeral joint with application of valgus stress. At arthroscopy ulnar Collateral Ligament tears may be visual...

Joshua S. Dines - One of the best experts on this subject based on the ideXlab platform.

  • Elbow Ulnar Collateral Ligament Injury - Elbow Ulnar Collateral Ligament Injury
    2015
    Co-Authors: Joshua S. Dines, David W Altchek
    Abstract:

    Elbow ulnar Collateral Ligament injury : , Elbow ulnar Collateral Ligament injury : , کتابخانه دیجیتال جندی شاپور اهواز

  • combined flexor pronator mass and ulnar Collateral Ligament injuries in the elbows of older baseball players
    American Journal of Sports Medicine, 2010
    Co-Authors: Daryl C. Osbahr, Swarup S Swaminathan, Struan H Coleman, Answorth A Allen, Joshua S. Dines, David W Altchek
    Abstract:

    BackgroundUlnar Collateral Ligament reconstruction techniques have afforded baseball players up to a reported 90% return to prior or higher level of play. A subpopulation exists with less impressive clinical outcomes potentially related to the presence of a concomitant flexor-pronator mass injury.Hypothesis/PurposeCombined flexor-pronator and ulnar Collateral Ligament injuries occur in older players, and results in this group are inferior to those reported for isolated ulnar Collateral Ligament reconstructions.Study DesignCase Series; Level of evidence, 4.MethodsAll baseball players who had ulnar Collateral Ligament reconstructions by 1 surgeon over a 6-year period were identified, and the authors studied those treated for a combined flexor-pronator and ulnar Collateral Ligament injury. The ulnar Collateral Ligament reconstruction was accomplished using the docking technique, and the flexor-pronator injury was treated with debridement if tendinotic or reattachment if torn. A 2-sample t test was conducted ...

  • glenohumeral internal rotation deficits in baseball players with ulnar Collateral Ligament insufficiency
    American Journal of Sports Medicine, 2009
    Co-Authors: Joshua S. Dines, Meredith Akerman, Joshua B Frank, Lewis A. Yocum
    Abstract:

    BackgroundThe kinetic chain of the throwing motion functions to optimize efficiency of proximal segments to decrease force loads seen at smaller, distal segments such as the ulnar Collateral Ligament. Several studies have shown that shoulder internal rotation forms the physiologic counter to the valgus torque generated during the late cocking phase of throwing. Previous studies have implicated decreased glenohumeral internal rotation as a cause of shoulder internal impingement. To date, an association between pathologic glenohumeral internal rotation deficit and elbow injury has not been exhibited.HypothesisThrowers with ulnar Collateral Ligament insufficiency will exhibit significantly increased glenohumeral internal rotation deficit.Study DesignCase control study; Level of evidence, 3.MethodsTwenty-nine baseball players with ulnar Collateral Ligament insufficiency were demographically matched with 29 control baseball players who had no history of shoulder, elbow, or cervical spine injury. The investigat...

  • Revision Surgery for Failed Elbow Medial Collateral Ligament Reconstruction
    The American journal of sports medicine, 2008
    Co-Authors: Joshua S. Dines, Lewis A. Yocum, Joshua B Frank, Neal S Elattrache, Ralph A. Gambardella, Frank W. Jobe
    Abstract:

    BackgroundAlthough excellent results can be achieved in up to 90% of primary elbow medial ulnar Collateral Ligament reconstructions, retears of the Ligament have been reported. As the number of primary reconstructions continues to increase, one could expect a commensurate increase in the number of revision medial Collateral Ligament reconstructions performed.HypothesisGiven the difficulty associated with revision procedures, the complication rate relative to primary reconstructions would increase while the percentage of athletes returning to their previous level of play would decrease.Study DesignCase series; Level of evidence. 4.MethodsThis was a retrospective review of 15 patients who underwent revision surgery for retear of a reconstructed elbow medial Collateral Ligament. All patients had undergone previous elbow medial Collateral Ligament reconstruction and had new history and physical examination findings consistent with medial Collateral Ligament injury. Twelve subjects were professional baseball p...

  • clinical outcomes of the dane tj technique to treat ulnar Collateral Ligament insufficiency of the elbow
    American Journal of Sports Medicine, 2007
    Co-Authors: Joshua S. Dines, John E Conway, Wade Smith, Neal S Elattrache, Christopher S. Ahmad
    Abstract:

    Background: Many improvements in ulnar Collateral Ligament reconstruction have been made since Jobe et al first described the procedure. A novel elbow ulnar Collateral Ligament reconstruction technique that combines interference screw fixation on the ulna with docking of the graft on the humeral side (DANE TJ) has been reported.Hypothesis: Outcomes of ulnar Collateral Ligament reconstructions performed with the DANE TJ technique are as good as other recently published results of ulnar Collateral Ligament reconstruction, particularly in cases of insufficient bone stock on the sublime tubercle and revision reconstructions.Study Design: Case series; Level of evidence, 4.Methods: During a 3-year period, 22 athletes were treated with surgical reconstruction of the ulnar Collateral Ligament using proximal docking and distal interference screw fixation of the Ligament (DANE TJ technique). All patients had a history, physical examination findings, and magnetic resonance imaging results consistent with ulnar colla...

Michelle G. Carlson - One of the best experts on this subject based on the ideXlab platform.

  • Thumb Collateral Ligament injuries in the athlete
    Current Reviews in Musculoskeletal Medicine, 2017
    Co-Authors: Daniel M. Avery, Elizabeth R. Inkellis, Michelle G. Carlson
    Abstract:

    Purpose of review The purpose of this review is to identify current principles in the diagnosis and treatment of Collateral Ligament injuries of the thumb in the athlete. Recent findings Cadaver studies have clearly identified the ulnar and radial Collateral Ligaments origin and insertion footprints for repair or reconstruction. Summary Ulnar and radial Collateral Ligament injuries are common in athletics. History and physical examination are paramount in determining partial versus complete tear. When surgical treatment is indicated, placing the repair/reconstruction in the anatomic footprint restores stability while maintaining motion. The senior author’s preferred techniques are reported.

  • Thumb Collateral Ligament injuries in the athlete
    Current Reviews in Musculoskeletal Medicine, 2017
    Co-Authors: Daniel M. Avery, Elizabeth R. Inkellis, Michelle G. Carlson
    Abstract:

    The purpose of this review is to identify current principles in the diagnosis and treatment of Collateral Ligament injuries of the thumb in the athlete. Cadaver studies have clearly identified the ulnar and radial Collateral Ligaments origin and insertion footprints for repair or reconstruction. Ulnar and radial Collateral Ligament injuries are common in athletics. History and physical examination are paramount in determining partial versus complete tear. When surgical treatment is indicated, placing the repair/reconstruction in the anatomic footprint restores stability while maintaining motion. The senior author’s preferred techniques are reported.

  • Thumb metacarpophalangeal joint Collateral Ligament injury management.
    Hand clinics, 2012
    Co-Authors: Arthur T. Lee, Michelle G. Carlson
    Abstract:

    The thumb Collateral Ligaments at the metacarpophalangeal joint are important to the elite athlete for precision grip and pinch. Injuries to these Ligaments can result in pain and instability and are seen at a higher frequency at the elite level. Whereas the Collateral Ligament tears used to be associated primarily with recreational skier's injury, these injuries have been reported with increasing frequency in major professional sports. The ulnar Collateral and radial Collateral Ligament injuries of the thumb occur through different mechanisms and are described in separate sections given the differences in their anatomy.

Rick W Wright - One of the best experts on this subject based on the ideXlab platform.

  • ulnar Collateral Ligament reconstruction a systematic review
    Clinical Orthopaedics and Related Research, 2007
    Co-Authors: Derek B Purcell, Matthew J Matava, Rick W Wright
    Abstract:

    Injury to the ulnar Collateral Ligament of the elbow is a commonly recognized lesion in the overhead throwing athlete. The techniques for reconstruction of this critical Ligament have evolved over time. The outcomes of ulnar Collateral Ligament reconstruction were assessed for success. We systematic

  • Ulnar Collateral Ligament reconstruction: a systematic review.
    Clinical orthopaedics and related research, 2007
    Co-Authors: Derek B Purcell, Matthew J Matava, Rick W Wright
    Abstract:

    Injury to the ulnar Collateral Ligament of the elbow is a commonly recognized lesion in the overhead throwing athlete. The techniques for reconstruction of this critical Ligament have evolved over time. The outcomes of ulnar Collateral Ligament reconstruction were assessed for success. We systematically reviewed the literature and found five Level III retrospective cohort studies that reported outcomes after reconstruction. One study reflected shorter term followup on a cohort that was included in a later study. Successful outcomes were based primarily on the return to play level of the athlete. Articles were reviewed with regard to population, followup, operative technique, adjunctive procedures, complications, and outcomes. The figure-of-eight and docking techniques for ulnar Collateral Ligament reconstructions provide high levels of return to sport for the overhead athlete. The most common complications were associated with the ulnar nerve. Transition to the muscle-splitting approach has decreased the occurrence of these complications. Areas for future research are also discussed.

David W Altchek - One of the best experts on this subject based on the ideXlab platform.

  • Elbow Ulnar Collateral Ligament Injury - Elbow Ulnar Collateral Ligament Injury
    2015
    Co-Authors: Joshua S. Dines, David W Altchek
    Abstract:

    Elbow ulnar Collateral Ligament injury : , Elbow ulnar Collateral Ligament injury : , کتابخانه دیجیتال جندی شاپور اهواز

  • combined flexor pronator mass and ulnar Collateral Ligament injuries in the elbows of older baseball players
    American Journal of Sports Medicine, 2010
    Co-Authors: Daryl C. Osbahr, Swarup S Swaminathan, Struan H Coleman, Answorth A Allen, Joshua S. Dines, David W Altchek
    Abstract:

    BackgroundUlnar Collateral Ligament reconstruction techniques have afforded baseball players up to a reported 90% return to prior or higher level of play. A subpopulation exists with less impressive clinical outcomes potentially related to the presence of a concomitant flexor-pronator mass injury.Hypothesis/PurposeCombined flexor-pronator and ulnar Collateral Ligament injuries occur in older players, and results in this group are inferior to those reported for isolated ulnar Collateral Ligament reconstructions.Study DesignCase Series; Level of evidence, 4.MethodsAll baseball players who had ulnar Collateral Ligament reconstructions by 1 surgeon over a 6-year period were identified, and the authors studied those treated for a combined flexor-pronator and ulnar Collateral Ligament injury. The ulnar Collateral Ligament reconstruction was accomplished using the docking technique, and the flexor-pronator injury was treated with debridement if tendinotic or reattachment if torn. A 2-sample t test was conducted ...

  • medial ulnar Collateral Ligament reconstruction of the elbow in throwing athletes
    American Journal of Sports Medicine, 2006
    Co-Authors: Christopher C. Dodson, Adrian Thomas, Riley J. Williams, Joshua S. Dines, David W Altchek
    Abstract:

    BackgroundMedial ulnar Collateral Ligament insufficiency of the elbow can be a devastating injury in the throwing athlete. Reconstruction of the medial ulnar Collateral Ligament was initially described by Jobe and associates; good clinical results have been described after this procedure. The authors' experience with this technique raised several concerns, and thus the “docking” procedure was developed as an alternative method for medial ulnar Collateral Ligament reconstruction of the elbow. The early results of the docking technique were good. The authors wish to investigate the intermediate-term clinical results of this method in a large group of athletes.HypothesisThe docking technique can return overhead-throwing athletes to sport with minimal perioperative morbidity.Study DesignCase series; Level of evidence, 4.MethodsDuring a 3-year period, 100 consecutive overhead-throwing athletes were treated with surgical reconstruction using the docking technique. The inclusion criteria were as follows: (1) a h...

  • Management of Medial Collateral Ligament Tears in the Athlete
    Operative Techniques in Sports Medicine, 2006
    Co-Authors: Christopher C. Dodson, David W Altchek
    Abstract:

    Medial Collateral Ligament insufficiency of the elbow can be a debilitating injury that often prevents athletes from competing effectively. The overhead athlete is particularly susceptible to this injury because the anterior bundle of the medial Collateral Ligament is the primary restraint to the valgus stress that is created during the throwing motion. Repetitive trauma from constant overhead or throwing activity can ultimately render the Ligament incompetent and cause recurrent pain and instability. We have found that the only reliable way to return these athletes to sport is by Ligament reconstruction. We currently use a “docking technique” that provides excellent graft fixation, the identification and treatment of intra-articular pathology, and the reduction of ulnar nerve related complications. This article details the assessment of the throwing athlete with valgus instability secondary to medial Collateral Ligament insufficiency and highlights the technical aspects for reconstruction.