Ulnar collateral ligament reconstruction, also known as Tommy John surgery (TJS) , is a surgical transplant procedure in which the ulnar collateral ligament in the medial elbow is replaced with the tendon from elsewhere in the patient's body, or the tendon from donation networks. This procedure is common among college athletes and professionals in some sports, especially baseball.
This procedure was first performed in 1974 by orthopedic surgeon Frank Jobe, a Los Angeles Dodgers team doctor who served as special advisor to the team until his death in 2014. Named after the first baseball player to undergo surgery, Tommy John's main league pitcher his 288 career victory record was ranked seventh among left-handed pitchers. The initial operation, John's successful post-operative career, and the relationship between the two men were the subject of the documentary ESPN 30 for 30 2013.
Video Ulnar collateral ligament reconstruction
Origin
At the time of Tommy John's surgery, Dr. Jobe put the odds for successful operation on 1 out of 100. In 2009, the prospect of complete recovery has increased to 85-92 percent.
After the 1974 operation, John missed the entire 1975 season rehabilitating his arm before returning for the 1976 season. Before surgery, John had won 124 matches. He won 164 games after the surgery, retiring in 1989 at the age of 46.
For baseball players, full rehabilitation takes about a year for the pitcher and about six months for the player's position. Players usually start throwing about 16 weeks after surgery. While eighty percent of players return to the field at the same level as before the operation, for Major League throwers who receive twice the operation, thirty-five percent do not return to the field in the department at all.
Maps Ulnar collateral ligament reconstruction
Injury Factor
The ulnar collateral ligament (UCL) may become stretched, frayed, or torn through repetitive stresses of throwing motions. The risk of injury to UCL throwing athletes is considered very high as the amount of stress through this structure approaches its main tensile strength during hard throws.
This injury is attributed to baseball, although it sometimes appears in other sports. Compared to athletes who play other sports, baseball players are at a higher risk than the average of excessive injuries and injuries caused by early sports specializations among children and adolescents.
While some sources say that the throwing style of the individual or the type of throw they throw is the most important determinant of their likelihood of sustaining an injury, the 2002 study results show that the number of throws thrown is the greatest determinant. A 2002 study examined throwing pitch, pitch, and 426 pitcher threads from 9 to 14 years old for one year. Compared to pitchers who throw 200 or less pitches in a season, those who throw 201-400, 401-600, 601-800, and 800 pitches face an increased risk of 63%, 181%, 234%, and 161% respectively. Types of throws show a smaller effect; throwing sliders is associated with an increased chance of elbow injury of 86%, while curveball throwing is associated with increased pain. There is only a weak correlation between throwing mechanics that are considered as bad and prone to injury. Thus, while there is plenty of other evidence that suggests an error in throwing mechanics increases the likelihood of injury, it seems that the greater risk lies in the total throw volume. Research into the field of throwing injuries to young athletes has led to age-based recommendations for pitch limits for young athletes. A 2016 study describes 22% of variation in those requiring reconstruction of ulnar collateral ligaments, citing handedness, standard deviation from release points, days lost due to arm and shoulder injuries, previous ulnar collateral ligament reconstruction, number of hard throws, ERA-, and age. as a known risk factor.
In younger athletes, where the epiphyseal plate (the growth plate) is still open, the force inside the elbow while throwing is more likely to cause the elbow to fail at this point than on the ulnar collateral ligament. These injuries are often termed "Little League elbow" and can be serious but do not necessarily reconstruct UCL.
The more often, pitchers require a second procedure after returning to pitching - the period from 2001-2012 and 2013-2015 both see the eighteen Major League pitchers receiving the procedure for the second time. In April 2015, the median time between the procedures was 4.97 years.
Surgical procedure
A 3-4 inch surgical incision is made near the elbow. Holes to accommodate replacement transplant tendons were drilled in the ulna and elbow bone humerus. Harvested tendons, such as the palmar tendon of the opposite or opposite elbow arm, patellar tendon, hamstring, extensor leg or donor tendon (allograft), are then wound in a pattern of the number eight through the hole and anchored. The ulnar nerve is usually transferred to prevent pain because scarring can put pressure on the nerves. This procedure is performed on an outpatient who allows the return to home on the same day, with the arm in a splint to protect the repair for the first week. After one week, the brace was used to protect the reconstruction for about six weeks after surgery.
Risk
There is a risk of damage to the ulnar nerve.
Misconceptions
Some baseball pitchers believe they can throw more hard after reconstruction of the ulnar collateral ligament than ever before. As a result, orthopedic surgeons have reported that young throwing parents have come to them and asked them to perform procedures on their uninjured son in the hope that this will improve their son's performance. However, many people - including Dr. Frank Jobe - believes that post surgical improvement is most likely due to increased elbow joint stability and increased thoracic attention to their fitness and conditioning. Jobe believes that, rather than allowing pitchers to gain speed, operation and rehabilitation protocols only allow pitchers to return to their level of performance before injury.
Teen
Over the past two decades, the number of UCLR operations has tripled, an incident that is expected to increase in the coming years. A study of youth who underwent UCLR surgery showed that boys and girls ages 15 to 19 had more surgical procedures than other age groups, with surgery performed at ages 15 to 19 increased by 9% per year.
Baseball USA, Major League Baseball and Little League Baseball have started a Smart Pitch program designed to reduce the risk of elbow injuries in teen pitchers. The main risk factors for elbow injuries from hand throws include the number of pitches per game, pitched inning per season, pitched month per year and poor throwing biomechanics that can increase torque and strength at the elbow.
References
Source of the article : Wikipedia
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