Conservative Versus Surgical Management of Elbow Medial Ulnar Collateral Ligament Injury: A Systematic Review

Abstract

ObjectiveSeveral studies have been published regarding the treatment of medial ulnar collateral ligament (MUCL) injuries for professional overhead athletes. However, there is a paucity of data regarding non‐professional athletes. The aim of this systematic review was to compare the rate of outcome scores and complications of conservative versus operative treatments both in non‐professional athletes and in non‐sport‐related trauma patients with MUCL lesions.MethodsA systematic review of the published literature was performed by applying the PRISMA guidelines. A search was conducted using three databases: Medline, Science Direct, and Web of Science. The keywords used were “ulnar collateral ligament injury,” “elbow,” “surgery,” and “conservative treatment”. Patients were divided into three groups: patients who underwent conservative treatment (C‐group), surgical treatment (S‐group), and surgery after a failed conservative treatment (C&S‐group). Clinical outcomes were analyzed: Disability of Arm, Shoulder and Hand (DASH), Conway scale, Carson score, and Kerlan–Jobe Orthopaedic Clinic score (KJOC).ResultsA total of 15 studies were included, evaluating 513 patients. Although good and excellent outcomes were found for most patients during daily and/or sport activities, independently of the type of treatment, the C‐group had better results. Excellent results were found in 98.8% of the C‐group, in 88.1% of the S‐group, and in 87.7% of the C&S‐group. The complication rate in the C‐group was statistically higher compared to the S and C&S groups (P < 0.001). However, its complication rate was higher with lower patient satisfaction.ConclusionsThere is insufficient evidence to establish statistically significant differences in the effects of conservative versus surgical treatments on the functional outcomes of patients with MUCL lesions. However, a period of rehabilitation therapy and the functional request of the single injured subject are useful to discern which patients genuinely require MUCL surgical repair.

Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

“… 11 For the nonelite athletes and laborers, it continues to be unclear whether nonoperative management or surgical treatment leads to better functional outcomes. 5 However, as demonstrated in the current study, performing a trial of nonoperative management followed by allograft MUCL reconstruction may serve as a reasonable treatment pathway resulting in acceptable outcomes for laborers and nonathletes.…”

“…Generally, it is understood that MUCL insufficiency requires treatment to restore valgus elbow stability, participate in athletics, and enjoy uninhibited performance of activities of daily living. 5 Nonoperative management is often the initial treatment of choice and continues to be a suitable definitive option in a certain subset of patients with MUCL injuries. Nonoperative candidates are often patients with a history, examination, and imaging consistent with low-grade partial tearing of the UCL; nonelite throwers; or those with goals of care not dependent on placing repetitive high valgus stresses across the elbow.…”

Translation step-cut osteotomy for posttraumatic Cubitus Varus in adults: a retrospective study

“…Meanwhile, O’Driscoll et al [ 3 ] have suggested that for a tardy posterolateral rotatory instability caused by cubitus varus, osteotomy alone may be adequate if there is only subtle instability or if the patient places only limited demands on the elbow. Carlo et al [ 28 ] have suggested that even high function demand patients (for whom ligament reconstruction is indicated) should be initially treated with a brief period of rehabilitation for at least 3 months. In the present study, although the cubitus varus deformity before surgery had a mean value of 26°, only corrective osteotomy was performed since there was no posterolateral instability.…”

The Chinese version of the American shoulder and elbow surgeons standardized shoulder assessment form questionnaire, patient self-report section: a cross-cultural adaptation and validation study

“…A shoulder pathology may lead to pain, disability, and immobility which eventually affect one’s activity of daily living (ADL) and quality of life (QOL) resulting in a socio-economic burden [ 2 , 4 , 5 ]. Similarly, elbow pain due to instability or consequences of traumatic events compromised one’s QOL as well [ 6 ]. To reach a better prognosis in approaching shoulder and elbow disorders, functional improvement is an essential outcome.…”