Date of Graduation

12-2019

Document Type

Thesis

Degree Name

Bachelor of Science

Degree Level

Undergraduate

Department

Health, Human Performance and Recreation

Advisor/Mentor

McDermott, Brendon P.

Committee Member/Reader

Gallagher, Kaitlin M.

Committee Member/Second Reader

Washington, Tyrone

Abstract

Background: Ulnar Collateral Ligament Reconstruction (UCLR) is a surgical procedure on one of the main ligaments that provides normal stability for the elbow joint against excessive valgus stress. Damage to this ligament is common in athletes performing overhead throwing activities, primarily baseball players, due to excessive valgus stress during the throwing motion. The most common form of treatment for this type of injury is reconstructive surgery of the ligament, especially if athletes wish to return to sport participation. This type of surgery is extremely invasive and requires extensive post-operative rehabilitation in order to facilitate return to play. To date, many surgical techniques have been proposed and evaluated, but there are no conclusive comparison studies on patient outcomes following UCLR. Purpose: The purpose of this paper is to analyze previous studies on UCLR techniques and determine if there is a single superior surgical method leading to improved biomechanical outcomes and decreased failure measures. Our focused clinical question was identifying if the traditional docking technique compared to novel docking techniques during UCLR superior in relation to biomechanical outcomes and failure measures in cadaveric tissue. Methodology: The study design in this paper is a critically appraised topic. Various scholarly databases such as PubMed, MEDLINE and SportDiscus were utilized to search for studies related to UCLR surgical techniques. After an initial search, a list of fifteen relevant studies were identified. Each study was then scrutinized and evaluated to meet predetermined inclusion criteria and a minimum score of 6/9 on the PEDro scale. All studies not meeting these requirements were excluded. This left a total of five articles which were then used to answer the clinical question for this paper. The inclusion criteria involved meeting a cadaveric age of 16-60 y, objective measures of valgus testing, angular displacement, stiffness and modes of failure as post-operative outcomes. Further, we included studies that had a minimum of seven cadaver pairs tested, and studies were required to compare traditional docking to at least one novel technique. Results: All five studies involved compared at least one novel surgical technique to the docking technique. Four studies found no significant overall difference between the native and reconstructed states of any surgical technique. One study found no overall significant difference, but did identify slight differences in biomechanical properties. Discussion: All conclusions from individual studies demonstrate comparable findings between all UCLR techniques. Biomechanics, kinematics and failure modes in the acute stages following surgery in cadavers are similar between UCLR techniques. Despite all that has been done, additional research is still necessary to determine a superior surgical technique.

Keywords

surgical procedures; ligament reconstruction; biomechanics; throwing athletes; baseball

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