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Medial Ulnar Collateral Ligament Injury
Posted: Jan 23 2022 #(C101948)
A

Medial Ulnar Collateral Ligament Avulsion in 16M

HPI

A 16-year-old high school, RHD, wrestler presents with right elbow pain following a takedown during a competition where he attempted to break his fall with this outstretched right hand. He felt a pop and instant pain and was unable to continue the match following this. The pain in the elbow has improved but he still has significant feelings of apprehension with the elbow.

PMH

Denies any elbow issues prior to this injury. Clavicle fracture was successfully treated non-operatively at age 13.

PE

Patient is 6'2 and 208 lbs. The elbow shows full and symmetric motion compared to the contralateral side. Point tenderness over the sublime tubercle with positive moving valgus and milking maneuver. No tenderness over the flexor-pronator tendon and no pain with resisted wrist flexion. Negative tinels over the ulnar nerve and it does not subluxate. No tenderness at the radiocapitellar joint.

Poll
1 of 10
1. In addition to plain film radiographs, would you obtain any other imaging studies to guide management?
No - current radiographs are sufficient
10%
60/563
Yes- additional radiographic views (XR) (includes stress views)
3%
21/563
Yes - CT scan of the elbow (CT)
3%
21/563
Yes - MRI of the elbow (MRI)
66%
372/563
Yes - XR + CT
0%
3/563
Yes - XR + MRI
8%
50/563
Yes - CT + MRI
2%
16/563
Yes - XR + CT + MRI
1%
7/563
Outside my area of expertise - best if I don't vote
2%
13/563
2. How would you manage this injury?
Nonoperative
27%
151/540
Operative
65%
354/540
Outside my area of expertise - best if I don't vote
6%
35/540
3. If you choose Operative management, how would you treat the medial ulnar collateral ligament injury (MUCL)?
I would not choose Operative management
7%
41/523
MUCL Repair
51%
268/523
MUCL Reconstruction
35%
185/523
Outside my area of expertise - best if I don't vote
5%
29/523
4. If you choose MUCL Reconstruction, what type of graft would you use?
I would not choose MUCL Reconstruction
15%
68/426
Ipsilateral palmaris longus autograft
48%
206/426
Contralateral palmaris longus autograft
4%
18/426
Ipsilateral hamstring autograft
5%
22/426
Contralateral hamstring autograft
1%
5/426
Other autograft
0%
2/426
Allograft
5%
25/426
Suture only (e.g. Internal Brace)
8%
35/426
Outside my area of expertise - best if I don't vote
10%
45/426
5. If you choose MUCL Reconstruction, which technique would you use?
I would not choose MUCL Reconstruction
17%
80/463
Traditional Jobe technique (Figure-of-8 with two connected bone tunnels in medial epicondyle)
11%
52/463
Modified Jobe technique (More anterior medial epicondyle tunnels to avoid ulnar nerve irritation)
23%
111/463
Docking technique (Single bone tunnel in medial epicondyle)
21%
99/463
Hybrid interference-screw technique
8%
39/463
Other
1%
8/463
Outside my area of expertise - best if I don't vote
15%
74/463
6. If you choose medial ulnar collateral ligament repair (MUCL Repair), how would you secure the ligament repair?
I would not choose MUCL Repair
8%
37/428
Suture anchors
56%
243/428
Bone tunnels
23%
102/428
Cortical suspensory device
3%
14/428
Other
0%
4/428
Outside my area of expertise - best if I don't vote
6%
28/428
7. If you choose medial ulnar collateral ligament Repair (MUCL Repair), would you use anything to augment the Repair?
I would not choose MUCL Repair
6%
27/403
No - I would not augment the repair
25%
101/403
Yes - Suture augmentation (i.e internal brace)
48%
195/403
Yes - Tendon autograft augmentation
8%
36/403
Yes - Tendon allograft augmentation
2%
10/403
Other
0%
0/403
Outside my area of expertise - best if I don't vote
8%
34/403
8. If you choose medial ulnar collateral ligament Repair (MUCL Repair) with suture augmentation, at what degree of flexion would you tension it?
I would not choose MUCL Repair with suture augmentation
6%
27/403
0 degrees
3%
16/403
15 degrees
5%
22/403
30 degrees
36%
146/403
45 degrees
17%
69/403
60 degrees
6%
25/403
75 degrees
1%
7/403
90 degrees
9%
37/403
Outside my area of expertise - best if I don't vote
13%
54/403
9. If you choose medial ulnar collateral ligament Repair (MUCL Repair), how would you manage the ulnar nerve?
I would not choose Operative management
3%
12/383
I would not address the ulnar nerve
30%
118/383
In situ ulnar nerve decompression only
41%
159/383
Subcutaneous ulnar nerve transposition
9%
37/383
Subfascial ulnar nerve transposition
4%
16/383
Submusclar ulnar nerve transposiiton
1%
7/383
Other
0%
1/383
Outside my area of expertise - best if I don't vote
8%
33/383
10. If you choose medial ulnar collateral ligament Repair (MUCL Repair), how long would you anticipate until they can return to sporting competition without restrictions?
I would not choose MUCL repair
2%
11/383
< 3 months
4%
19/383
3-6 months
46%
178/383
7-9 months
22%
87/383
10-12 months
10%
42/383
> 12 months
5%
20/383
Outside my area of expertise - best if I don't vote
6%
26/383
PROCEDURE #1

Right medial ulnar collateral ligament repair with suture augmentation

Intra-procedure P1
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