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Abstract
The purpose of this study was to evaluate the humeral tunnel characters and clinical relevance according to entry point of the humeral tunnel in the baseball players. It was hypothesized that the medial collateral ligament (MCL) reconstruction with nonanatomical starting location of the humeral tunnel (inferior edge of the medial epicondyle: group NA) provided less favorable radiological and clinical outcomes compared to that with anatomical starting location (original footprint of the MCL: group A). The retrospective case review yielded 19 consecutive athletes who underwent isolated MCL reconstruction using the docking technique. Three dimensional-computed tomography scan was performed at 3 months, and the iso-surfacing by marching cubes algorithm were applied to evaluate the length and angle of humeral tunnel. Three outcome measures were used in this study: the visual analog scale for pain, range of motion and the Conway scale. The angle of the humeral tunnel was measured 12.2o (range, 7.9o−25.2o) in the group NA and 15.5o (range, 9.8o−30.4o) in the group A (p＜0.05). The mean length of humeral tunnel is measured 16.3 mm (range, 11.7−20.1 mm) in the group NA and 15.2 mm (range, 10.3−19.1 mm) in the group A (p＜0.05). MCL reconstruction brought substantial improvement in pain and function. However, between-group comparison revealed no statistical differences in all outcome measurements. The MCL reconstruction using the docking technique provided favorable clinical outcomes in baseball players. Although the humeral tunnel angle and length were different depending on the humeral entry points, clinical differences between the two entry points were not found.
References
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Fig. 1.
Images of three dimensional reconstructed computed tomography showing the starting point of the humeral tunnel: (A) inferior point, (B) anteroinferior point.
Fig. 2.
A photograph of screenshot showing measuring process of the length and angle of the humeral tunnel using the iso-surfacing by marching cubes algorithm (A) and formation of angle with humeral axis (B).
Table 1.
Demographics
| Variable | Group NA∗ (n=9) | Group A† (n=10) |
|---|---|---|
| Age (yr) | 21.9 (17−28) | 20.8 (18−29) |
| Side (right：left) | 7：2 | 9：1 |
| Follow-up (mo) | 25.1 (24−36) | 24.6 (24−32) |
| Grade‡ | 5, 2, 2 | 3, 4, 3 |
| Position§ | 7, 1, 1 | 8, 2, 0 |
| Arthroscopic spur | 5 | 4 |
| resection |
Table 2.
Clinical outcomes
| Variable | Group NA∗ (n=9) | Group A† (n=10) | p-value |
|---|---|---|---|
| Preoperative VAS for pain, mean (range) | 6.0 (3−8) | 6.3 (3−8) | NS |
| Postoperative VAS for pain, mean (range) | 0.5 (0−4) | 0.4 (0−3) | NS |
| Preoperative range of motion‡ | 3.3/132.1/77.8/64.4 | 1.0/133.0/80.0/72.5 | NS |
| Postoperative range of motion | 0/137.2/80.0/73.3 | 0.5/135.5/79.0/76.0 | NS |
| Conway scale§ | 7, 1, 1, 0 | 9, 0, 0, 1 | NS |
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