Tulane University Department of Orthopaedic Surgery, New Orleans, LA 70112, USA.
J Bone Joint Surg Am. 2013 Jun 19;95(12):1062-6. doi: 10.2106/JBJS.L.00213.
Currently, several graft options have been described for reconstruction of the medial ulnar collateral ligament of the elbow. Palmaris longus, gracilis, plantaris, toe extensor, and even Achilles tendon autografts have been well documented. To our knowledge, no study has investigated the clinical outcomes following the use of allograft tendon for primary medial ulnar collateral ligament reconstruction. It is our hypothesis that medial ulnar collateral ligament reconstruction with hamstring allograft provides results similar to those reported with autograft without the potential complication or risk of donor-site morbidity.
We retrospectively reviewed the records for 123 overhead throwing athletes with medial ulnar collateral ligament injuries who had had unsuccessful nonoperative treatment. All patients were managed with reconstruction with use of a hamstring allograft and were followed for a minimum of twenty-four months. One hundred and sixteen of the 123 patients were contacted and were included in our study. Outcome measures included Conway-Jobe rating scale, the mean time to return to play, the maximum level of competition, and overall satisfaction with the reconstruction.
At the time of the most recent follow-up, 110 of the 116 patients had returned to play. Thirty-three (30%) of these 110 athletes had returned to a level of play above that prior to injury, sixty-four (58%) had returned to play at the same level, and thirteen (12%) had returned to level of play lower than that that prior to the injury. The mean time to return to play was 9.9 months. One hundred and fourteen of the 116 patients who were contacted considered the reconstruction to be successful. The Conway-Jobe score was classified as excellent for 80% of the patients, good for 13%, fair for 7%, and poor for none.
The use of allograft tissue for the reconstruction of the medial ulnar collateral ligament in throwing athletes provides outcomes similar to that of autograft tissue after twenty-four months of follow-up.
目前，已经有几种移植物选择被描述用于重建肘部的内侧尺侧副韧带。已经有很好的文献记载了掌长肌、股薄肌、趾伸肌，甚至跟腱的自体移植物。据我们所知，尚无研究调查同种异体肌腱用于原发性内侧尺侧副韧带重建后的临床结果。我们的假设是，使用腘绳肌同种异体移植物进行内侧尺侧副韧带重建可提供与自体移植物相似的结果，而没有潜在的并发症或供区发病率的风险。
我们回顾性地审查了 123 例有内侧尺侧副韧带损伤的 overhead 投掷运动员的记录，这些患者的非手术治疗均不成功。所有患者均采用腘绳肌同种异体移植物重建治疗，随访时间至少 24 个月。123 例患者中有 116 例被联系并纳入我们的研究。评估指标包括 Conway-Jobe 评分量表、重返赛场的平均时间、最高比赛水平以及对重建的总体满意度。
在最近一次随访时，116 例患者中有 110 例重返赛场。这 110 名运动员中有 33 名（30%）的运动水平高于受伤前，64 名（58%）恢复到相同的运动水平，13 名（12%）的运动水平低于受伤前。重返赛场的平均时间为 9.9 个月。联系到的 116 名患者中有 114 名认为重建是成功的。Conway-Jobe 评分为 80%的患者为优秀，13%为良好，7%为可接受，无较差。
在 24 个月的随访后，同种异体组织用于投掷运动员的内侧尺侧副韧带重建的结果与自体移植物相似。
