Origin of the Medial Ulnar Collateral Ligament on the...
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![Page 1: Origin of the Medial Ulnar Collateral Ligament on the ...apps.sportsmed.org/meetings/am2013/files/Poster_61.pdfinjuries in throwing athletes. Am J Sports Med. 2001; 29(1):15-17. 7.](https://reader036.fdocuments.in/reader036/viewer/2022070721/5ee1e732ad6a402d666c9b7d/html5/thumbnails/1.jpg)
Origin of the Medial Ulnar Collateral Ligament on the
Pediatric Elbow!
Michael Zell, BS!Jerry R Dwek, MD!
Eric W Edmonds, MD!
We have no poten+al conflicts with this presenta+on
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Ulnar Collateral Ligament Injuries
• The anterior bundle of the UCL (aUCL) serves as the primary stabilizer of the elbow against valgus stress during the late-cocking and early acceleration phases of the overhead throwing or striking motion.2,3
• aUCL injuries are most commonly seen in the context of overhead athletes (baseball, football, volleyball, etc.) and acute upper extremity trauma.3
• In the adult population, surgical repair of the aUCL is a common and established treatment that yields satisfactory results.
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Ulnar Collateral Ligament Injuries in the Pediatric Population
• Child athletes are at particular risk to unique chronic repetitive stress injuries of the aUCL related to two specific factors: 1) open growth plates, and 2) the evolution of youth sports from seasonal activities to year-round training.2
• Surgical reconstruction of the aUCL is becoming more popular for the adolescent athlete and is complicated by the attachment of the aUCL near the developing medial epicondyle apophysis.5,7,8
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Purpose!• The purpose of this study was to
determine the gender-specific anatomic origins of the aUCL in relation to the medial epicondyle apophysis based on different skeletally immature age groups.
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Materials & Methods!• A retrospective comparative analysis of 90 pediatric
patients (68 boys, 22 girls) receiving elbow MRI between 2009 and 2012, grouped by age and gender.
– Mean age 12.8 years (range 6-18 years)
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Radiographic Assessment! Figure 1: Coronal T1 Fat Saturated MRI image demonstra+ng the sublime tubercle of the ulna (A), the apophysis of the medial epicondyle (arrowheads), and the UCL (B).
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Figure 2: Coronal T1 Fat Saturated MRI image demonstra+ng (A) width of the UCL origin along the medial epicondyle, and the (B) distance from the medial epicondyle apophysis to the midpoint of the UCL origin. !
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Results!• Comparing genders across age groups,
boys were found to have a wider aUCL than girls.
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Results!• No difference in the origin of the UCL relative to the
medial epicondyle apophysis between gender, between gender age-matched groups, or within gender age-matched groups.!
• However, the origin of the UCL always remained medial to the non-ossified lateral margin of the apophysis (denoted by negative value below).!
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Discussion!• Recent systematic review of aUCL reconstruction in adults
demonstrates excellent outcomes, defined as the ability to return to the same or higher level of competition within one year, in >80% of patients.10
• Surgical indications and guidelines for aUCL reconstruction in the pediatric and adolescent population include consideration of the developing anatomy of the elbow.
• Reconstruction of this ligament, in this age group, places the apophysis at risk for injury and possible partial arrest.
• The clinical significance of a complete or partial apophyseal arrest at the medial epicondyle is unknown.
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Discussion!• This study demonstrates that the anatomic origin of the
aUCL is relatively consistent across age and gender for children with an open medial epicondyle apophysis centered approximately 3 mm medial to the lateral edge of the apophysis.
• This location may be important when considering childhood medial epicondyle fractures and future stability to the ulnohumeral joint.
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Conclusions!• Increasingly, youth athletes are engaging in overuse
throwing habits, resulting in injury to the aUCL.
• Should a surgical reconstruction be indicated, operative techniques should be chosen in consideration of the risk it poses to the development of the elbow.
• Our study suggests that the origin for the reconstructed ligament in relation to the medial epicondyle apophysis does not require specific consideration of either age or gender; but rather, an understanding that anatomic repair of the aUCL will violate the apophyseal cartilage.
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References!1. Greiwe RM, Saifi C, Ahmad CS. Pediatric sports elbow injuries. Clin Sports Med. 2010; 29(4):677-703. 2. Cain EL, Jr., Andrews JR, Dugas JR, Wilk KE, McMichael CS, Walter JC, 2nd, et al. Outcome of ulnar collateral
ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010; 38(12):2426-2434.
3. Dugas JR, Ostrander RV, Cain EL, Kingsley D, Andrews JR. Anatomy of the anterior bundle of the ulnar collateral ligament. J Shoulder Elbow Surg. 2007; 16(5):657-660.
4. Kramer DE. Elbow Pain and Injury in Young Athletes. Journal of Pediatric Orthopaedics. 2010; 30:S7-S12. 5. Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball
players: clinical results and injury risk factors. Am J Sports Med. 2004; 32(5):1158-1164. 6. Rettig AC, Sherrill C, Snead DS, Mendler JC, Mieling P. Nonoperative treatment of ulnar collateral ligament
injuries in throwing athletes. Am J Sports Med. 2001; 29(1):15-17. 7. Vitale MA, Ahmad CS. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a
systematic review. Am J Sports Med. 2008; 36(6):1193-1205. 8. Olsen SJ, 2nd, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in
adolescent baseball pitchers. Am J Sports Med. 2006; 34(6):905-912. 9. Savoie FH, 3rd, Trenhaile SW, Roberts J, Field LD, Ramsey JR. Primary repair of ulnar collateral ligament injuries
of the elbow in young athletes: a case series of injuries to the proximal and distal ends of the ligament. Am J Sports Med. 2008; 36(6):1066-1072.
10. Purcell DB, Matava MJ, Wright RW. Ulnar collateral ligament reconstruction: a systematic review. Clin Orthop Relat Res. 2007; 455:72-77.
11. Azar FM, Andrews JR, Wilk KE, Groh D. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med. 2000; 28(1):16-23.
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Thank you