The Elbow Wrapping It Up Koco Eaton M

The Elbow: Wrapping It Up Koco Eaton, M. D.

Tommy John’s Surgery - 1974 n n n 1974 surgery Has four 20 game win seasons after surgery, none before 1972 – Tommy John undergoes open arthrotomy for posterior osteophytes

Tommy John’s Surgery - 1974 n n n Detachment of flexor mass Second surgery 3 months later for ulnar nerve palsy Ulnar nerve palsy delays rehab

Elbow Instability Conway et al, JBJS 1992 n n 71 patients 21% ulnar nerve dysfunction 8 patients required revision surgery 5 patients with permanent partial ulnar nerve palsy

Elbow Instability Thompson, Jobe, Yocum & Pink, JSES 2001 n n 83 athletes Muscle-splitting approach without transposition of the ulnar nerve 5% transient ulnar nerve symptoms One ulnar nerve palsy lasted 6 months, but resolved without a second operation

Elbow Instability Thompson et al. n n Better results if first procedure 82% success rate including all subjects 93% success if first elbow procedure Previous procedure usually olecranon decompression with removal of posterior osteophytes

Elbow Instability Hetchman et al, AJSM 1998 n n n Suture anchors rather than drill holes Small series Cadaver study – anchors comparable to bone tunnels

Elbow Instability Rohrbough, Altchek & Hyman, AJSM 2002 n n Docking procedure Muscle-splitting approach 97% return to sports One tunnel in humerus

Elbow Instability n n n Graft harvest Palmaris longus not always available Fourth toe extensor on opposite side of elbow Long, usually > 20 cm Low morbidity

Valgus Stress Radiograph

Epicondylar Drill Holes

Graft Placement

Anterior Tunnel

Ulnar Nerve Transposition

Conclusion We have come a long way in 30 years, but we still have further to go.