一般 2「UCL 1」

2月3日（金）14:45～15:15
第2会場（山形テルサ 1F テルサホール）

English & Japanese Oral Session 2 "UCL 1"

Feb. 3rd（Fri）14:45～15:15
Room 2（Yamagata Terrsa 1F Terrsa Hall）

O2-1

Change in Humeral Anchor Position Significantly Affects Isometry in
UCL Repair: A 3-Dimensional Computer Modeling Study
Matthew S. Fury 1, Tianyu Liu 2, Evan A. O’Donnell 3, Luke S. Oh 3
1

Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, USA,
Department of Radiology, Massachusetts General Hospital, Boston, USA,3Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA2S179

一般

Objectives: Medial ulnar collateral ligament（UCL）repair utilization is increasing in recent years,
bolstered by shorter rehabilitation and satisfactory clinical outcomes. While previous literature has
illustrated the importance of tunnel position on restoring graft isometry in UCL reconstruction,
there remains a paucity of literature guiding anchor placement in UCL repair. Herein, we describe a
3-dimensional（3D）elbow model to measure and optimize anchor location during UCL repair.
Methods: A 3D computer model of a human elbow joint was created using CT and MRI images froma single patient. The humeral and ulnar attachments of the UCL were plotted using three distinct
methodologies: 1）geometric cloud mapping; 2）quantitative measurements as described by theanatomical studies by Camp et al1; and 3）Frangiamore et al2. A 3.5mm-diameter clockface was placedon each attachment site which allowed for simulation of 12 distinct, 1.75mm deviations in anchor
position. The three elbow models were then ranged through 0-120 degrees of flexion at 10-degreeincrements, and the 3D distances were measured between the two ligament centroids. The humeraland ulnar anchors were sequentially repositioned around the clockfaces, and ligament lengths wereagain measured to evaluate changes in isometry. An independent t-test was performed to determine
if there was a significant difference in isometry between the humeral or ulnar anchor deviations.
Results: Using method 1, the UCL length at 90 degrees of elbow flexion was 26.8mm. This ligament
underwent 13.6mm of total excursion for a 46.4% change in length throughout arc of motion. Method
2 produced a 19.3mm ligament that underwent 0.8mm of excursion for a 3.9% length change
throughout the arc. Method 3 produced a 24.5mm ligament that underwent 2.3mm of excursion for a
9.4% length change throughout arc. Identifying ligament footprints using the quantitative anatomicalmeasurements as described by Camp et al 1 and Frangiamore et al 2 produced better ligamentisometry through 120 degrees of flexion（ligament length changes of 3.9% and 9.4%, respectively）
when compared to using the geometric cloud technique（46.4% length change）.
Humeral anchor
deviations produced a statistically significant increase in ligament excursion when compared to ulnar
anchor deviations（p < 0.001）.
Conclusion: When performing UCL repair, small deviations in humeral anchor position may
significantly influence graft and ligament isometry. Anchor position was most isometric while
using the quantitative measurements as described in Camp et al 1. Particularly when addressing
detachments of the humeral footprint, surgeons should be critical of the humeral anchor position inorder to restore native anatomy and optimal biomechanics.

一般 2「UCL 1」

2月3日（金）14:45～15:15
第2会場（山形テルサ 1F テルサホール）

English & Japanese Oral Session 2 "UCL 1"

Feb. 3rd（Fri）14:45～15:15
Room 2（Yamagata Terrsa 1F Terrsa Hall）

O2-2

Self-controlled case series を用いた内側型野球肘からTommy John 手術へのリスク比根津 智史 1、島村 安則 2、中道 亮 2、齋藤 太一 2、三橋 利晴 3、尾﨑 敏文 21

鳥取市立病院整形外科、2 岡山大学大学院医歯薬学総合研究科整形外科、3 岡山大学病院新医療研究開発センター統計解析室

Risk of Little Leaguer’s Elbow to Tommy John Surgery Using SelfControlled Case Series

Satoshi Nezu 1, Yasunori Shimamura 2, Ryo Nakamichi 2, Taichi Saito 2, Toshiharu Mitsuhashi 3,Toshifumi Ozaki 2
1

Department of Orthopaedic Surgery, Tottori City Hospital,Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,3
Center for Innovative Clinical Medicine, Okayama University Hospital2

一般【目的】内側型野球肘（以下 LLE）は投球時の肘外反力を高め、肘内側側副靱帯（以下 UCL）への動的ストレスを上昇させる要因と考えられている。しかし LLE 症例に対し縦断的追跡研究を継続することは難しく、LLE 発症がその後の UCL 損傷や Tommy John 手術（以下 TJS）に与える影響は不明である。SelfControlled Case Series（以下 SCCS）はイベントが生じた対象自身をコントロールとし、暴露から調査期間内に生じるアウトカムの発生率比を調べる研究デザインである。目的は SCCS を用いて LLE 発症から5年以内に TJS に至る発生リスク比を調査すること。
【方法】2017年から2021年に TJS を受けた45名の中高校生野球選手を対象とした。全例が小学生から野球を開始し、LLE の既往歴はカルテ内情報、受診時や検診時の野球問診表から得た。SCCS では①野球開始
年齢から② TJS 実施までを観察対象期間とし、③ LLE 発症（暴露）から④5年間（60か月）を焦点期間と定め、TJS の実施が焦点期間内か焦点期間外かを比較しリスク比を R を用いて算出した。
【結果】LLE 既往は 35 名に認め、複数回発症は 12 名、初回 LLE 発症平均年齢は 11.4 歳で TJS 実施時平均年齢は 16.5 歳であった。LLE 発症から 5 年以内の TJS 発生リスク比は 2.389 倍（95%CI: 1.146 to 5.385、p=0.0256）多かった。
【考察】中高校生の野球選手にとって LLE の発症は UCL 損傷および TJS に発展するリスクを高める。

S180

2022年10月22日（土）～10月23日（日）一般 2「UCL 1」

2月3日（金）14:45～15:15
第2会場（山形テルサ 1F テルサホール）

English & Japanese Oral Session 2 "UCL 1"

Feb. 3rd（Fri）14:45～15:15
Room 2（Yamagata Terrsa 1F Terrsa Hall）

O2-3

Low Rates of Postoperative Complications and Revision Reconstruction
After Primary Elbow Ulnar Collateral Ligament Repair in 286 Patientswith Minimum 2-Year Follow-Up
Jay Moran 1, Alexander Kammien 1, Kyle N. Kunze 2, Robert A. Cecere 2, Joseph E. Manzi 2,Allen D. Nicholson 2, Ravi Vaswani 2, Andrew E. Jimenez 1, Joshua S. Dines 2, David W. Altchek 2
1

Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA,The Hospital for Special Surgery, New York, NY, USA

2

S181

一般

Background: Recent innovative techniques and biomechanical evidence have generated revived
interest in repair of medial ulnar collateral ligament（UCL）injuries. However, data regarding
postoperative complications and revision surgery is limited.
Purpose: To evaluate the 90-day postoperative complications and incidence of revision surgery
following primary UCL repair at minimum 2-year follow-up.
Study Design: Case Series, Level of Evidence, 4.
Methods: A retrospective review of a national insurance database was conducted from 2015 to 2020 toidentify patients with documented UCL injuries that underwent a primary UCL repair with minimum
2-year follow-up data. Patients >40 years of age, those with concomitant elbow fracture, dislocation,
radial lateral collateral ligament injures, medial epicondylitis, a history of previous elbow surgery/injury, and/or elbow arthritis were excluded. The number of patients that underwent concomitantulnar nerve transposition or decompression during the primary UCL repair was recorded. Rates of90-day postoperative complications, including ulnar neuropathy（both new and persistent cases）,
superficial wound complications, and elbow stiffness were assessed. Subsequent ulnar nerve surgeries
after the primary UCL repair were also tracked. The incidence and timing of revision UCL surgery,defined by ipsilateral revision UCL reconstruction or revision repair, were tracked using Kaplan-Meieranalysis.
Results: In total, 286 patients that underwent primary UCL repair met inclusion criteria with anaverage follow-up of 3.9 ± 1.2 years. The average age was 20.4 ± 7.0 years, with 62.9% of patients
being male. Concomitant ulnar nerve decompression or transposition was performed in 34.2%（98/286）
of patients at the time of primary UCL repair. The most common 90-day postoperative complication
was ulnar neuropathy（N=15, 5.2%）, while surgical site infections, wound dehiscence, hematoma
formation, elbow stiffness, and medial epicondyle fractures were much less common（<2%）. Of the 15
patients with postoperative ulnar neuropathy, 5（33%）underwent subsequent ulnar nerve surgery（2primary and 3 secondary）at an average of 1-year after the primary UCL repair. The revision UCL
surgery rate was low（1.0%, 3/286）at an average follow-up of 3.9 ± 1.2 years and all 3 patients wereconverted to a UCL reconstruction 9 months after the primary repair.
Conclusion: The most common postoperative complication for patients that underwent primary UCL
repair was ulnar neuropathy（5.2%）, with 33% of those requiring a subsequent ulnar nerve surgery
within a year after the primary UCL repair. At an average follow-up of 3.9 years, the rate of revision
surgery was only 1%（3/286）, and all 3 patients underwent a revision UCL reconstruction 9 months
after the primary UCL repair.