Sports Medicine Center, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Shoulder and Elbow Unit, Joint Research, Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
J Shoulder Elbow Surg. 2019 Aug;28(8):1497-1504. doi: 10.1016/j.jse.2019.01.017. Epub 2019 Apr 23.
The purpose of this study was to increase our understanding of the pathoanatomy of the ulnar collateral ligament (UCL) by performing a descriptive analysis of the surgical inspection of the anterior bundle in patients undergoing reconstruction.
A single-surgeon series of 163 patients who underwent UCL reconstruction between 2009 and 2017 was retrospectively analyzed. Descriptions of the pathoanatomy of injury were obtained from the operative reports. Magnetic resonance imaging data were reviewed to assess whether the presence and location of tissue disruptions were accurately recognized. Demographic and clinical characteristics were obtained from medical records and correlated to observed pathoanatomy.
Injuries to the anterior bundle were characterized by a single tissue disruption (65%), tissue disruptions at more than 1 location (23%), or injuries without distinct fiber tissue disruptions (12%). The presence and location of tissue disruptions matched magnetic resonance imaging findings in 124 of 153 patients (81%). Partial tears more frequently affected the anterior band of the anterior bundle distally as opposed to the posterior band of the anterior bundle proximally (P = .012). Patients with single tissue disruptions more frequently reported a popping sensation than patients with non-tear insufficiency (P = .030).
This study shows the heterogeneity of anterior bundle injuries in patients undergoing UCL reconstruction. A variety of injury configurations and chronic attritional damage to the anterior bundle were observed, as well as distinct tear patterns at the distal and proximal attachment sites. Future research may elucidate the diagnostic value of a pop sign for UCL injury.
本研究旨在通过对接受重建手术的患者的前束进行手术检查，对尺侧副韧带（UCL）的病理解剖进行描述性分析，从而加深我们对其的理解。
回顾性分析了 2009 年至 2017 年间接受 UCL 重建的 163 例单外科医生系列患者。从手术报告中获取损伤的病理解剖描述。评估磁共振成像（MRI）数据是否准确识别组织破裂的存在和位置。从病历中获得人口统计学和临床特征，并与观察到的病理解剖相关联。
前束损伤的特征为单一组织破裂（65%）、多于 1 个部位的组织破裂（23%）或无明显纤维组织破裂的损伤（12%）。在 153 例患者中有 124 例（81%）MRI 检查发现的组织破裂位置和损伤位置与手术所见相匹配。与近端前束的后束相比，前束的前带更常发生部分撕裂（P =.012）。与非撕裂不全患者相比，单一组织破裂患者更常报告弹响声（P =.030）。
本研究表明接受 UCL 重建的患者前束损伤存在异质性。观察到多种损伤结构和前束慢性磨损性损伤，以及在远近端附着点有明显的撕裂模式。未来的研究可能阐明 UCL 损伤的弹响声的诊断价值。
