Sambare Namit D, Chalmers Peter N, Camp Christopher L, Bowman Eric N, Erickson Brandon J, Sciascia Aaron, Freehill Michael T, Smith Matthew V
Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
JSES Rev Rep Tech. 2024 Feb 20;4(2):182-188. doi: 10.1016/j.xrrt.2024.01.011. eCollection 2024 May.
HYPOTHESIS AND/OR BACKGROUND: The incidence of elbow medial ulnar collateral ligament (MUCL) injuries has been increasing, leading to advances in surgical treatments. However, it is not clear that there is consensus among surgeons regarding diagnostic imaging, the indications for acute surgery and postoperative rehabilitation. The purpose of this study is evaluate surgeon variability in the presurgical, surgical, and postsurgical treatment of MUCL injuries regarding the imaging modalities used for diagnosis, indications for acute surgical treatment, and postoperative treatment recommendations for rehabilitation and return to play (RTP). Our hypothesis is that indications for acute surgical treatment will be highly variable based on MUCL tear patterns and that agreement on the time to RTP will be consistent for throwing athletes and inconsistent for nonthrowing athletes.
A survey developed by 6 orthopedic surgeons with expertise in throwing athlete elbow injuries was distributed to 31 orthopedic surgeons who routinely treat MUCL injuries. The survey evaluated diagnostic and treatment topics related to MUCL injuries, and responses reaching 75% agreement were considered as high-level agreement.
Twenty-four surgeons responded to the survey, resulting in a 77% response rate. There is 75% or better agreement among surveyed surgeons regarding acute surgical treatment for distal full thickness tears, ulnar nerve transposition in symptomatic patients or with ulnar nerve subluxation, postoperative splinting for 1-2 weeks with initiation of rehabilitation within 2 weeks, the use of bracing after surgery and the initiation of a throwing program at 3 months after MUCL repair with internal brace by surgeons performing 20 or more MUCL surgeries per year. There were a considerable number of survey topics without high-level agreement, particularly regarding the indications for acute surgical treatment, the time to return to throwing and time RTP in both throwing and nonthrowing athletes.
DISCUSSION AND/OR CONCLUSION: The study reveals that there is agreement for the indication of acute surgical treatment of distal MUCL tears, duration of bracing after surgery, and the time to initiate physical therapy after surgery. There is not clear agreement on indications for surgical treatment for every MUCL tear pattern, RTP time for throwing, hitting and participation in nonthrowing sports.
假设和/或背景：肘部内侧尺侧副韧带（MUCL）损伤的发生率一直在上升，这推动了手术治疗的进展。然而，目前尚不清楚外科医生在诊断性影像学检查、急性手术指征和术后康复方面是否达成了共识。本研究的目的是评估外科医生在MUCL损伤的术前、术中和术后治疗方面的差异，包括用于诊断的影像学检查方式、急性手术治疗的指征以及术后康复和恢复运动（RTP）的治疗建议。我们的假设是，基于MUCL撕裂模式，急性手术治疗的指征将存在很大差异，并且对于投掷运动员，恢复投掷时间的共识将是一致的，而对于非投掷运动员则不一致。
由6名擅长治疗投掷运动员肘部损伤的骨科医生制定的一项调查问卷，分发给31名常规治疗MUCL损伤的骨科医生。该调查问卷评估了与MUCL损伤相关的诊断和治疗主题，达到75%一致的回答被视为高度一致。
24名外科医生回复了调查问卷，回复率为77%。在接受调查的外科医生中，对于远端全层撕裂的急性手术治疗、有症状患者或尺神经半脱位患者的尺神经转位、术后1 - 2周的夹板固定并在2周内开始康复、术后使用支具以及每年进行20次或更多MUCL手术的外科医生在MUCL修复后3个月使用内置支具开始投掷训练等方面，达成了75%或更高的一致意见。有相当数量的调查主题没有达成高度一致，特别是关于急性手术治疗的指征、恢复投掷的时间以及投掷和非投掷运动员的恢复运动时间。
讨论和/或结论：该研究表明，对于远端MUCL撕裂的急性手术治疗指征、术后支具固定的持续时间以及术后开始物理治疗的时间存在共识。对于每种MUCL撕裂模式的手术治疗指征、投掷、击球和参与非投掷运动的恢复运动时间，目前尚无明确的共识。
