Cirugía de "Tommy John" en paciente adolescente lanzador de béisbol / Tommy John surgery in adolescent baseball pitcher

La lesión del ligamento colateral cubital (LCC) es una patología debilitante del codo, con alta prevalencia en deportistas. En este trabajo expondremos el caso de una reconstrucción del ligamento colateral cubital realizada en un beisbolista masculino de dieciséis años, mediante un abordaje con la técnica quirúrgica de docking.

Ulnar collateral ligament (UCL) injury is a debilitating pathology of the elbow, with high prevalence in athletes. We describe the case of a UCL reconstruction performed in a 16-year-old male baseball player, using the Docking surgical technique.

Elbow Ulnar Collateral Ligament Injuries in Throwing Athletes: Diagnosis and Management.

Ulnar collateral ligament (UCL) injuries of the elbow are common in overhead throwing athletes. With throwing, the elbow experiences substantial valgus stress and repetitive microtrauma can lead to injury. Increasing rates of injury among both youth and professional throwers has resulted in a "UCL epidemic." Ulnar collateral ligament reconstruction ("Tommy John Surgery") became a part of the public consciousness after Tommy John returned to professional baseball after a UCL reconstruction with Dr Frank Jobe for what was once considered a career-ending injury. Partial tears and some athletes with complete UCL injuries can be managed without surgery. Since the introduction of UCL reconstruction, technical modifications have aimed to decrease complications and increase return-to-play rates. Ulnar collateral ligament repair has reemerged as a potential surgical option for some throwers. Future prospective and comparative studies are necessary to better define the optimal operative treatment for these injuries.

Bipolar Disruption of the Lateral Ulnar Collateral Ligament of the Elbow: A Case Report.

CASE: The lateral ulnar collateral ligament (LUCL) is one of the primary stabilizers of the elbow. Disruption typically occurs from the humeral origin and may be because of an elbow dislocation or fracture/dislocation. If not identified and properly managed, posterolateral rotatory instability may result from LUCL insufficiency. We describe the case of a patient with bipolar LUCL disruption consisting of an avulsion fracture of the crista supinatoris and a soft-tissue avulsion from the lateral epicondyle. CONCLUSION: Bipolar disruption of the LUCL is a previously unreported injury pattern that may lead to posterolateral instability if not identified and treated.

Técnica de larson original modificada para la reconstrucción del ligamento colateral lateral de la rodilla, reporte de un caso / Modified original larson technique for the knee´s lateral collateral ligament reconstruction, a case report

El ligamento colateral lateral (LCL), que forma parte de los estabilizadores de la rodilla, constituye una estructura importante dentro del complejo posterolateral de la misma (CPL), que restringe al varo, en los ángulos de flexión de esta, especialmente a los 30°, además de controlar la rotación externa. Son infrecuentes las lesiones que afectan a este complejo, etiológicamente entre el 50- 90% se asocian a otras lesiones ligamentosas con predominio del 60% de daño del ligamento cruzado posterior. La técnica de Larson se basa en la reconstrucción del LCL y del complejo poplíteo, utilizando una inserción proximal única en el epicóndilo femoral. Presentamos el caso de un paciente masculino de 28 años de edad, sin antecedentes clínicos, que acude debido a un varo forzado de la extremidad mientras realizaba actividad deportiva y tras recibir impacto directo en la región lateral interna de pantorrilla derecha, posterior a lo cual presenta dolor a los movimientos pasivos e imposibilidad a la deambulación. Además, presenta equimosis, edema, escoriaciones superficiales en cara lateral externa y dolor a la digitopresión en trayecto de ligamento colateral externo. A maniobras de exploración de rodilla: signo de bostezo en varo positivo, cepillado rotuliano positivo, hiperpresión de rotula positivo, limitación funcional a la flexión y extensión de la articulación. Esta técnica, Larson modificada, resulta como una de las más prometedoras por sus varias características, como la menos exigente y al mismo tiempo brindando resultados alentadores. Este procedimiento se fundamenta en la reconstrucción del LCL y del tendón poplíteo (TP) en conjunto, resumiéndose así la reconstrucción del Ligamento Poplíteo Peroneo (LPP) como estabilizador estático del TP, con su inserción a nivel de la cabeza del peroné en conjunto con la del LCL y la restitución de ambas inserciones en el epicóndilo femoral, tomando en cuenta la morfología del peroné y los ángulos de movimientos de la rodilla.

The lateral collateral ligament (LCL), which is part of the knee stabilizers, constitutes an important structure within the posterolateral complex of the same (CPL), which restricts the varus, in the flexion angles of this, especially at 30°, in addition to controlling external rotation. Lesions that affect this complex are infrequent, etiologically between 50-90% are associated with other ligamentous injuries with a predominance of 60% damage to the posterior cruciate ligament. The Larson technique is based on the reconstruction of the LCL and the popliteal complex, using a single proximal insertion in the femoral epicondyle. We present the case of a 28-year-old male patient, with no medical history, who attended due to a forced varus of the limb while performing sports activity and after receiving a direct impact on the internal lateral region of the right calf, after which he presented pain to passive movements and inability to ambulation. In addition, he presents ecchymosis, edema, superficial abrasions on the external lateral aspect and pain on acupressure in the course of the external collateral ligament. A knee examination maneuvers: positive varus yawn sign, positive patellar brushing, positive patella hyperpressure, functional limitation to flexion and extension of the joint. This modified Larson technique turns out to be one of the most promising due to its various characteristics, as the least demanding and at the same time providing encouraging results. This procedure is based on the reconstruction of the LCL and the popliteal tendon (PT) as a whole, thus summarizing the reconstruction of the Peroneal Popliteal Ligament (LPP) as a static stabilizer of the PT, with its insertion at the level of the head of the fibula in conjunction with the of the LCL and the restitution of both attachments in the femoral epicondyle, taking into account the morphology of the fibula and the angles of movement of the knee.

Lesión complejo ligamentario interno del codo por valgo forzado sin luxación previa / Internal ligament complex elbow injury without previous dislocation

Se presenta el reporte de un caso de un paciente que consulta por dolor e inestabilidad de codo izquierdo tras un traumatismo directo realizando práctica deportiva. En el examen físico se constata bostezo medial de más de 4 mm tras maniobras de stress. Los estudios por imágenes informan avulsión del complejo ligamentario interno y desprendimiento de la masa muscular flexopronadora. Se realizó la reparación directa de las estructuras dañadas, se utilizó el DASH score (00.0), el score de la Clínica Mayo (100.0) para la evaluación y seguimiento del paciente

We present the case report of a patient who consulted for pain and instability of the left elbow after a direct trauma doing sports practice. In the physical examination, a medial opening of more than 4mm was observed after stress maneuvers. Imaging studies report avulsion of the internal ligament complex and detachment of flexopronator muscle mass. Direct repair of the damagedstructures was performed, the DASH score (00.0), the Mayo Clinic score(100.0) was used for the evaluation and follow-up of the patient

Cadaveric Biomechanical Analysis of 3 Lateral Ulnar Collateral Ligament Reconstructions.

OBJECTIVE: To biomechanically assess the angular stability provided by 3 techniques for reconstruction of the lateral ulnar collateral ligament. METHODS: Eight cadaveric elbows were tested with the lateral collateral ligament complex intact, disrupted from the origin at the lateral epicondyle, and reconstructed with 3 different techniques using ulnar bone tunnels: a suture "lasso" or palmaris longus tendon "lasso" both docked with a metal button at the origin, and a doubled-over palmaris longus tendon docked with metal buttons at both the origin and ulnar insertion. Elbows were tested with a physiologic elbow simulator, and varus angular position was quantified with an optical tracking system. Statistical analysis was performed using a repeated measures analysis of variance test to determine whether significance existed, and a Tukey post hoc analysis to compare statistical difference between native, disrupted, and repair states. RESULTS: There was a statistically significant difference between all repairs and the disrupted state (P < 0.05). The varus angulation after the repairs showed that the suture reconstruction was closest to the native case. The tendon reconstructions were similar to each other but less similar to the native elbow. Quantitatively, the suture reconstruction was within an average of 0.86 degrees of the native elbow throughout range of motion. CONCLUSIONS: A suture reconstruction was most similar to a native elbow, but both tendon reconstructions significantly improved angular stability under varus gravitational loads.

Reparación artroscópica con anclas sin nudo para las lesiones 1B y 1C del complejo fibrocartílago triangular / Arthroscopic repair with knotless anchors for 1B and 1C complex triangular fibrocartilage lesions

Las lesiones del complejo fibrocartílago triangular (CFCT) comienzan a ser más frecuentes en la consulta diaria, con el advenimiento de la artroscopia de muñeca son múltiples las técnicas que se están realizando para la reparación de las lesiones tipo 1B y 1C de Palmer, en este trabajo presentamos nuestra experiencia en el uso de anclas sin nudos con paso de sutura vertical para la reparación del CFCT(AU)

The triangular fibrocartilage complex (TFCC) injuries are becoming more common in daily practice, with the advent of wrist arthroscopy are many techniques that are being made to repair Palmer´s lesions type 1B and 1C, in this paper we present our experience using knotless anchors with vertical suture passage to TFCC repai(AU)