Advancements in medicine cut down on recovery time
In 1974, orthopedic surgeon Dr. Frank Jobe invented a procedure called ulnar collateral ligament reconstruction, better known as Tommy John Surgery. Designed to repair elbow injuries, it was considered a ground-breaking procedure at the time.
El Dorado orthopedic surgeon Dr. Kenneth Gati said progress has been made in that area, including a new procedure which cuts the recovery time in half.
“It’s a nice advancement to sports medicine,” said Gati. “We also do it in the ankle. So, for ankle sprains, people who have reoccurring ankle sprains, you can do the same thing, reconstruct the ligament in the ankle to keep that from turning in.”
The Arthrex internal brace, also known as ligament augmentation repair, actually repairs the tendon instead of replacing it.
“I’ve only done it once so far. It’s still pretty new. And, I don’t know if anybody else (locally) has done it, yet,” said Gati. “Basically, this is an improvement to Tommy John Surgery.”
Gati explained the medical advancement.
“Before 1990, if you tore the ligament, they didn’t have any great way of fixing it,” he said. “Around the nineties, Dr. Jobe came up with a procedure to reconstruct the ligament. Tommy John was one of the first ones to get the surgery. Once this ligament was torn, they didn’t have a good way of just tying it back together.
"The surgery that has been for the last 30 years, is you took one of the tendons in the forearm called the palmaris longus, make a couple incisions, you harvest that tendon. Then you make the incision over the elbow.
"Through a tunnel, you reroute and make another ligament, using that tendon. That worked really good. It was an 80 percent return to the previous level of activity. But it takes a long time. You’ve got to let that heal into the bone. You’re looking at at-least a year before returning to a throwing activity. Over the last five, six years, they’ve developed this little brace.”
The updated procedure uses a size zero super suture, two 3.5 millimeter corkscrew
PEEK anchors and a collagen coated fiber tape. The suture acts as an internal brace.
“You repair the tear and this thing augments it, which reduces the recovery time,” Gati explained. “We’re looking at recovery time back to throwing, starting at three months. Hopefully by six months, competitive throwing again. Everything is probably cut in half. It’s sped up the recovery time without the morbidity of having to harvest from another part of the body.”
Gati said New Orleans Saints’ quarterback Drew Brees had the ulnar collateral repair on his thumb last season and was back on the field in five weeks instead of the normal 12.
“You repair the ligament and then implant the suture device, which tacks into the bone and allows you to start throwing and playing a lot sooner,” he said.
The procedure is used mostly on the elbow, especially baseball pitchers. It can also be done on the ankle or the thumb. Gati performed the procedure on the elbow.
“It was actually in a football player that sustained it. Not a quarterback. He was a defensive back. It was bad. His was almost a dislocation,” he said.
The procedure was created when doctors began asking if they were performing too much surgery. The ability to repair the ligament instead of replacing it with another body part just made sense.
“Instead of doing the full blown reconstruction, just repair the ligament and augment it with the suture device, the internal brace,” said Gati, who said, ultimately, the best action on these types of overuse injuries is preventative.
“I’m excited for it. The good news is, I think as a society, especially in baseball, we’re doing a better job of being educated about not overuse. Ulnar collateral injuries are usually overuse injuries. I think our coaches around here are doing a lot better job. Our parents are doing a better job of not letting their kids get overuse injuries. Definitely, the number of people when I first got here 20 years ago to now, the number of people coming in with elbow problems is less.”
Renowned surgeon Dr. James Andrews is credited with bringing to light the overuse of young arms.
“He was huge in putting out pitching limits and guidelines all the way from a little kid up to high school – how many pitches, if you throw so many pitches, how long you should rest, when do you throw again. I think the leagues are getting better at watching that,” said Gati.
But when an injury does occur, the internal brace
represents a major advance in sports medicine. Using the suture device to augment ligaments could extend throughout the body. It will definitely decrease the use of Tommy John surgery.
“Especially in younger kids, their ligament is still good, they just tore it. Instead of taking from one spot of the body and recreating in another spot, can we just repair what’s there and augment it and make it stronger,” he said. “That’s just one fascinating thing they’ve done in trying to get kids back to playing sooner.
“Our goal is to never have to fix those ligaments. The key to this is, we don’t want to have to do a whole bunch of these. We want pitchers, the athletes and parents and coaches to all be responsible in making sure we don’t have these injuries.”