Campbell Leonie, Bryan Tracey P, Edmonds Eric W
Department of Orthopaedic Surgery, Balboa Naval Medical Center, San Diego, California, USA.
Division of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA.
Orthop J Sports Med. 2024 Mar 5;12(3):23259671241228868. doi: 10.1177/23259671241228868. eCollection 2024 Mar.
Autograft palmaris has been the primary choice for the reconstruction of the medial ulnar collateral ligament (UCL) in the elbow. Agenesis of the palmaris tendon is not rare, and outcomes of allograft reconstruction in the breadth of athlete types found in the adolescent population are lacking.
Allograft tendon reconstruction of the medial UCL in the young elbow would have low failure rates and satisfactory outcome scores.
Case series; Level of evidence, 4.
The records of patients who underwent allograft medial UCL reconstruction (UCLR) by a single surgeon between 2009 and 2019 were reviewed. Patient-reported outcome scores in adolescent patients obtained at a minimum 4-year follow-up (for intermediate assessment) were recorded, with no exclusion according to sex or sport type. Outcomes included the Timmerman-Andrews score, the Single Assessment Numeric Evaluation (SANE), and the Conway-Jobe score.
Of 29 patients who underwent allograft UCLR, 10 adolescents (40% women; mean age at surgery, 15.8 years [age range, 15-17 years]) met the inclusion criteria and were included in the study. The mean follow-up was 8 years (range, 4.3-11.9 years). There were 4 overhead athletes (baseball, water polo) and 6 impact sports athletes (motocross, gymnastics, wrestling, and soccer). The mean SANE score was 86.3, and the mean subjective Timmerman-Andrews score was 92.5. The Conway-Jobe score was "excellent" in 7 of 10 participants; nonetheless, 3 elected not to return to sport (2 for reasons unrelated to the elbow). No patients experienced loss of range of motion, contracture, or ulnar nerve neuropathy. There was 1 patient with early failure (10%) who required revision reconstruction .
Allograft reconstruction for medial UCL instability in adolescent patients from sport and trauma mechanisms demonstrated excellent patient-reported functional scores in this study. If the patient and surgeon desire to avoid autograft morbidity or agenesis of the palmaris longus, allograft tendon UCLR appears viable for both the throwing and the high-impact adolescent athlete, regardless of sex.
自体掌长肌腱一直是重建肘部尺侧副韧带（UCL）的主要选择。掌长肌腱缺如并不罕见，目前尚缺乏针对青少年人群中各类运动员同种异体肌腱重建疗效的研究。
青少年肘部内侧UCL同种异体肌腱重建失败率低，疗效评分满意。
病例系列研究；证据等级为4级。
回顾了2009年至2019年间由同一外科医生进行同种异体UCL重建（UCLR）的患者记录。记录了青少年患者在至少4年随访（中期评估）时的患者报告结局评分，不根据性别或运动类型进行排除。结局指标包括Timmerman-Andrews评分、单项评估数字评价（SANE）和Conway-Jobe评分。
在29例行同种异体UCLR的患者中，10名青少年（40%为女性；手术时平均年龄15.8岁[年龄范围15 - 17岁]）符合纳入标准并纳入研究。平均随访时间为8年（范围4.3 - 11.9年）。其中有4名上肢运动运动员（棒球、水球）和6名冲击性运动运动员（摩托车越野、体操、摔跤和足球）。SANE评分平均为86.3，主观Timmerman-Andrews评分平均为92.5。10名参与者中有7名Conway-Jobe评分为“优秀”；然而，有3人选择不再参加运动（2人原因与肘部无关）。没有患者出现活动范围丧失、挛缩或尺神经病变。有1例患者早期失败（10%），需要翻修重建。
本研究表明，对于因运动和创伤机制导致青少年患者内侧UCL不稳定的同种异体肌腱重建，患者报告的功能评分良好。如果患者和外科医生希望避免自体肌腱的相关并发症或掌长肌腱缺如，同种异体肌腱UCLR对于投掷类和高冲击性的青少年运动员（无论性别）似乎都是可行的。
