Complications and Outcomes After Medial Ulnar Collateral Ligament Reconstruction

Somerson, Jeremy S.; Petersen, John P.; Neradilek, Moni B.; Cizik, Amy M.; Gee, Albert O.

doi:10.2106/jbjs.rvw.17.00138

Cited by 21 publications

(26 citation statements)

References 26 publications

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“…The first model compared the effect of graft technique (docking vs figure-of-8 technique) across all studies (Figure 4A). Consistent with the findings of previous literature, 42,46,48 this model demonstrated a significantly higher proportion of excellent outcomes with docking reconstructions (86.58%; 95% CI, 80.42%-91.85%) than with figure-of-8 reconstructions (76.76%; 95% CI, 69.65%-83.25%; P = .031; I 2 = 87.07%). The second model examined the effect of graft technique across studies in which FPM-preserving approaches were used and no routine submuscular ulnar nerve transpositions were performed (Figure 4B).…”

Section: Resultssupporting

confidence: 90%

“…Multiple systematic reviews have suggested improved outcomes after UCL reconstruction with the docking technique as compared with the figure-of-8 technique. 22,42,46,48 Recent findings of several comparative cohort and large database studies have suggested that the differences in outcomes are not statistically significant. 2,25,32 Likewise, our findings revealed no significant difference in the proportions of excellent outcomes between UCL reconstruction performed with docking and figure-of-8 techniques when the FPM is preserved and routine submuscular ulnar nerve transposition is abandoned, as well as no significant difference in the mean time to RTP between techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Using metaregression techniques to measure the association of various study characteristics with outcomes and determine risk differences among studies, Somerson et al 42 systematically reviewed 14 studies (1177 reconstructions), with an overall excellent outcome rate of 83.2% and an overall complication rate of 10.2%. In their analysis, the reconstruction with the docking technique had a 14% risk difference (95% CI, 6%-26%) for achieving an excellent outcome as compared with figure-of-8 ( P = .002).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, many of the conclusions about differences in outcomes and complications between the docking and modified Jobe techniques include results from the classic Jobe studies. 12,42,46,48 To our knowledge, separate analyses designed to compare the outcomes of docking and figure-of-8 techniques have not been conducted.…”

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confidence: 99%

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Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes

et al. 2020

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Background: The modified Jobe and docking techniques are the most common techniques used for elbow ulnar collateral ligament (UCL) reconstruction. Previous systematic reviews have suggested that the docking technique results in superior outcomes as compared with the Jobe (figure-of-8) technique. However, these included results from earlier studies in which the flexor-pronator mass (FPM) was detached and an obligatory submuscular ulnar nerve transposition was performed. Purpose/Hypothesis: The purpose was to compare the outcomes and return-to-play (RTP) time between the docking and figure-of-8 techniques for UCL reconstruction. We hypothesized that there would be no significant difference in the proportion of excellent outcomes between techniques when the FPM was preserved and no obligatory submuscular ulnar nerve transposition was performed. We also hypothesized that there would be no significant difference in RTP time between techniques. Study Design: Systematic review and meta-analysis. Methods: This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In the primary analysis, techniques were compared in random effects models by using the restricted maximum likelihood method, with weighted effect sizes calculated as the Freeman-Tukey double-arcsine transformed proportion of excellent outcomes for variance stabilization and with summary effects estimated from the inverse double-arcsine transformation per the harmonic mean of the sample sizes. Mean RTP times for techniques were compared in a separate model. Results: There were 21 eligible articles identified, with results for 1842 UCL reconstructions (n = 320, docking; n = 1466, figure-of-8). Without controlling for the effects of flexor-pronator detachment and submuscular ulnar nerve transposition, a significantly larger proportion of excellent outcomes was observed with docking reconstruction (86.58%; 95% CI, 80.42%-91.85%) than with figure-of-8 reconstruction (76.76%; 95% CI, 69.65%-83.25%; P = .031); however, there was no significant difference between techniques when controlling for FPM preservation or detachment with submuscular nerve transposition ( P = .139). There was no significant difference between techniques in time to return to sports ( P = .729), although no reconstructions with FPM detachment and submuscular ulnar nerve transposition were available for RTP time analysis. Conclusion: There was no significant difference in the proportion of excellent Conway Scale outcomes or RTP time between the docking and modified Jobe techniques for UCL reconstruction when the FPM was preserved and routine submuscular ulnar nerve transposition was not performed.

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Section: Resultssupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes

et al. 2020

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“…High-demand baseball pitchers are particularly prone to UCL injury and make up a large portion of patients undergoing UCL reconstruction. 15 In a survey of >5000 professional baseball players, 10% were found to have undergone at least 1 UCL reconstruction. Of the Major League Baseball (MLB) pitchers included in the survey, 25% reported that they had undergone the procedure.…”

mentioning

confidence: 99%

Outcomes With a Focus on Return to Play for Revision Ulnar Collateral Ligament Surgery Among Elite-Level Baseball Players: A Systematic Review

Glogovac

Grawe

2018

Am J Sports Med

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Background: Ulnar collateral ligament (UCL) reconstruction is commonly performed among overhead throwing athletes. Previous studies demonstrated relatively high rates of return to sport after primary reconstruction. Outcomes after revision UCL reconstruction have not been widely studied. Purpose: To report the rate of return to sport after revision UCL reconstruction among elite-level baseball players. Study Design: Systematic review. Methods: A systematic review of the literature following the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines was performed for high-level baseball players undergoing revision UCL reconstruction. Study bias was assessed with the Methodological Index for Non-Randomized Studies scoring system. The primary outcome measure was whether the study participants were able to return to sport after revision UCL reconstruction. Secondary outcome measures included career length after revision and pitching performance statistics. Data were summarized with ranges, tables, and weighted averages. A subjective analysis was performed. Results: A total of 5 studies met inclusion criteria. The rate of return to sport at preinjury level was 62.8%. Among Major League Baseball pitchers, the rate of return to sport at the preinjury level was 68.8%. The rate of return to sport at the same level or lower (Major League Baseball, minor league, collegiate) was 78.1%. Time to return to sport ranged from 1.3 to 1.7 years. Mean earned run average after revision ranged from 4.87 to 5.04. Mean number of innings pitched per season after revision ranged from 36.95 to 50.5. Conclusion: This systematic review demonstrated a limited rate of return to preinjury level of sport among elite-level baseball players who underwent revision UCL reconstruction. Pitching durability and career longevity were inferior to results that were reported for players who underwent primary UCL reconstruction alone. This study suggests that outcomes after revision UCL reconstruction are not reliable and elite-level players should be counseled accordingly.

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Elbow Injuries in the Overhead Athlete: MUCL Avulsion and Tears

Patel

Cotton-Betteridge

Savoie

et al. 2022

MRI-Arthroscopy Correlations

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Complications and Outcomes After Medial Ulnar Collateral Ligament Reconstruction

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 21 publications

References 26 publications

Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes

Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes

Outcomes With a Focus on Return to Play for Revision Ulnar Collateral Ligament Surgery Among Elite-Level Baseball Players: A Systematic Review

Elbow Injuries in the Overhead Athlete: MUCL Avulsion and Tears

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