To The Editor:
I read with interest the article "Traumatic Valgus Instability of the Elbow: Pathoanatomy and Results of Direct Repair" (2008;90:2416-22), by Richard et al. Repair of avulsion injuries of the ulnar collateral ligament has yielded better results than repair of midsubstance tears, but the superiority of the outcomes of operative treatment of isolated medial ligament injuries, as compared with the outcomes of nonoperative treatment, is questionable. I would like to ask the authors to comment on the following.
Posteromedial impingement of the elbow occurs in athletes who use overhead motions and manifests as terminal loss of extension and late-onset pain in the deceleration phase of throwing. Was posteromedial impingement of the olecranon seen in any of the athletes in their study?
Was there any specific reason for the performance of ulnar nerve transfer in all patients? Articles have shown that abandoning obligatory transposition of the ulnar nerve leads to better outcomes and decreased postoperative ulnar nerve neuropathy1.
In what degree of flexion of the elbow were the sutures secured, and were the sutures tensioned to any numerical value? In vitro studies have shown that overtensioning to >60 N leads to varus overtightening in midflexion, but its effects in vivo are yet to be proven2.