Modified Ligament Surgery Improves Outcomes -- MEDICA - World Forum for Medicine

"This paper, in the largest series of patients ever published, shows that this particular operation in throwing athletes demonstrates better results than the classic operation," said David W. Altchek, M.D., senior author of the study and co-chief of the Sports Medicine and Shoulder Service at Hospital for Special Surgery (HSS), New York.

Medial collateral ligament (MCL) injury is most common in professional and amateur athletes involved in so-called overhead throwing sports, such as baseball, softball, football, lacrosse and tennis. When the MCL is torn, an individual has a full range of motion and can go about daily life, but a professional or semi-professional athlete cannot perform at their usual level because they cannot exert a significant force.

Altchek’s method gains access to the bone in a different way than the traditional method. Altchek uses a muscle splitting technique through which surgeons can gain access to the bone by gently prying apart muscle fibers, reducing the problems of postoperative nerve damage.

In Altchek's surgery only one hole instead of three is drilled into the humerus. "In the classic operation, the graft enters the humerus bone in one hole, exits in another and goes into another and then the graft gets tied to itself," he explained. In the docking procedure, the graft enters the humerus bone, but never exits. Instead, sutures secure the tendon and exit the bone through much smaller exit punctures.

In a study of 100 athletes who had the docking surgery, with an average follow-up of three years, 90 percent had an excellent result (returned to the same or higher level of competition) and seven percent had a good result (able to compete at a lower level for more than twelve months). Only three percent had postoperative nerve complications. With the traditional surgery, studies have shown that only 68 percent of elite level throwers return to either their prior or a higher level of throwing and 20 percent have nerve complications.; Source: Hospital for Special Surgery