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

Abstract

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

Return-to-Sport Outcomes After Primary Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Tendon Grafts: A Systematic Review

“…Another consideration is that our study exclusively examined the use of autograft in UCLR; a growing body of literature is showing allografts to be comparable autografts for UCLR, particularly in nonelite athletes and laborers. 18 , 27 Future directions should also evaluate the role of graft choice in outcomes after revision UCLR, as the rate of this procedure has increased nearly 10-fold over the past few decades and presents new considerations regarding graft selection.…”

Operative Versorgungsmöglichkeiten für mediale Instabilitäten am Ellenbogen

“…Am häufigsten werden autologe Transplantate zur Rekonstruktion verwendet, u. a. Plantaris-, Gracilis-, Semitendinosus- und Achillessehnentransplantate 17 , 21 , 28 . Die Rekonstruktion mit Weichteil-Allotransplantaten hat sich als rationelle Alternative erwiesen, die ebenfalls hervorragende Ergebnisse und Return to Play (RTP) erzielt 20 , 32 , 42 , 45 , 58 . Einer der Vorteile der Verwendung von Allotransplantaten für MUCL-Rekonstruktion ist die Vermeidung einer möglichen Donor-Site-Morbidität nach Autotransplantat-Entnahme bei Hochleistungssportlern 2 , 6 , 11 , 37 , 65 .…”

“…[32] [42][45][58]. Einer der Vorteile der Verwendung von Allotransplantaten für MUCL-Rekonstruktion ist die Vermeidung einer möglichen Donor-Site-Morbidität nach Autotransplantat-Entnahme bei Hochleistungssportlern [2][6][11][37][65].…”

Biomechanical Properties of Knee Medial Collateral Ligament Compared to Palmaris Longus for Ulnar Collateral Ligament Reconstruction

“…infection, pain, and dysfunction at the graft site, hamstring muscle weakness, and accidental median nerve damage during PL tendon harvest have all been described [21,30]. To minimize these risk, allografts, connective tissue harvested from cadaveric donors, have been used with similar functional outcomes [21].…”

“…infection, pain, and dysfunction at the graft site, hamstring muscle weakness, and accidental median nerve damage during PL tendon harvest have all been described [21,30]. To minimize these risk, allografts, connective tissue harvested from cadaveric donors, have been used with similar functional outcomes [21]. While concerns regarding sterilization, added procedural costs, delayed graft incorporation, and disease transmission are associated with allograft tissue, improved preparation and surgical techniques are increasing interest in using allograft materials for ligament reconstruction procedures.…”