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Revision surgery for failed elbow medial collateral ligament reconstruction
Joshua S Dines1, Lewis A Yocum, Joshua B Frank
1Kerlan Jobe Orthopaedic Clinic, Los Angeles, California, USA. jdinesmd@gmail.com
Background:
Although excellent results can be achieved in up to 90% of primary elbow medial ulnar collateral ligament reconstructions, retears of the ligament have been reported. As the number of primary reconstructions continues to increase, one could expect a commensurate increase in the number of revision medial collateral ligament reconstructions performed.
Hypothesis:
Given the difficulty associated with revision procedures, the complication rate relative to primary reconstructions would increase while the percentage of athletes returning to their previous level of play would decrease.
Study Design:
Case series; Level of evidence. 4.
Methods:
This was a retrospective review of 15 patients who underwent revision surgery for retear of a reconstructed elbow medial collateral ligament. All patients had undergone previous elbow medial collateral ligament reconstruction and had new history and physical examination findings consistent with medial collateral ligament injury. Twelve subjects were professional baseball players and 3 were college-level players at the time of their revision procedure. Patients were evaluated at a minimum of 2 years after revision surgery. Outcomes were classified using the Conway scale.
Results:
Average time to revision was 36 months. The technique used in the revision was the Jobe technique in 11 cases, DANE TJ in 3, and primary repair in 1. Thirty-three percent (5/15 excellent) returned to their previous level of play for at least 1 season. Additionally, there were 4 good, 2 fair, and 4 poor results. The ligament repair had a good outcome. Forty percent (6/15) of patients had complications, 1 of whom required a subsequent surgery (lysis of adhesions). One subject experienced a retear of the medial collateral ligament.
Conclusion:
The rate of return to play after revision medial collateral ligament surgery is much lower than after primary reconstruction. As was expected, the complication rate of revision surgery is higher as well. This study should help physicians when counseling baseball players who suffer retears of their medial collateral ligament.