Common elbow injuries in adult athletes are epicondylitis, impingement, ligamentous injuries and tendon ruptures

Ulnar collateral ligament reconstruction

The most affected ligament in the elbow is the ulnar collateral ligament. The UCL is often ruptured after hypervalgus or hyperextension injuries, or after a posterolateral dislocation of the elbow. Chronic UCL insufficiency is seen in overhead throwing athletes. Historically, an injury of the UCL was career ending for the professional sports player. The first description of successful UCL reconstruction was from Jobe on major baseball pitcher Tommy John. Since that publication in 1986, the anatomy, pathophysiology, (surgical) treatment and rehabilitation of UCL injuries became a very popular area of research. This is reasonable as UCL reconstruction in professional baseball players has a relatively high prevalence of 10%. Over the years, many different reconstruction techniques have been developed, all with their pros and cons. However, the optimal surgical technique for UCL reconstruction is currently still subject to debate58. It is for instance unclear whether for UCL reconstruction one implant is superior to the other. Most series are from clinics in the USA and Asia, and it is uncertain if the same results apply for European athletes.

The purpose was therefore to describe the results of a new reconstruction technique of the UCL in European athletes with a triceps fascia autograft and interference screw technique fixation.

 

Distal biceps tendon reconstruction

Rupture of the distal biceps tendon is rare in overhead throwing athletes, but more common in weightlifting, bodybuilding and contact sports. Risk factors include male gender, smoking, use of steroids and statins, and high body mass index. In athletes, surgical reconstruction is favored as nonoperative treatment fails to restore flexion and supination strength. With new insights in distal biceps tendon anatomy, also various reconstruction techniques (with new implants) were developed. In general four different reconstruction techniques are used to re-fixate the distal biceps tendon to the radial bicipital tuberosity: 1) suture anchors, 2) bone tunnels, 3) cortical buttons, and 4) interference screws. These fixation methods can be performed using a single anterior incision approach or a double incision approach. Currently, it is still unclear which fixation technique and which approach is superior over the others. A systematic review by Chavan et al in 2008 evaluated and found no significant clinical difference between the different reconstruction techniques. A biomechanical comparison showed the highest load and stiffness for cortical button reconstructions. However, the cortical button was only used in one clinical study with only 10 patients by that time.