Ulnar Collateral Ligament Reconstruction: Allograft Versus Autograft – A Systematic Review

Abstract

Background: Ulnar Collateral Ligament (UCL) reconstruction of the elbow, a Tommy John surgery, is a common procedure often performed in throwing athletes. Autograft tendon has traditionally been utilized, although recently allograft tendon has been of interest due to the possibility of decreasing donor site morbidity. There is a lack of literature on patient outcomes and complication rates following the use of allograft tendon for UCL reconstruction. Currently, there is no consensus on utilizing autograft versus allograft tendon for UCL reconstruction.Methods: A PRISMA compliant literature search in online databases Medline, Cochrane and Embase was performed for level 4 and higher studies through June 2019. Any studies reporting clinical outcome results of allograft reconstruction were included. Exclusion criteria included studies unrelated to primary UCL reconstruction, studies specifically looking at revision UCL reconstruction, epidemiological studies, case reports, studies lacking raw data, technique articles, biomechanical studies, cadaveric studies, studies with outcomes unrelated to graft choice, and studies with outcomes unrelated to the use of allograft tendon for reconstruction. Studies were analyzed for graft type, functional scores, return to play rate, and complication rates.Results: Three out of 103 studies met inclusion criteria. Two cohort studies and 1 retrospective review were included in this review. No significant differences in functional outcomes regardless of scoring system utilized, return to play rate, or complication rates were found between allograft versus autograft. Conclusion:The use of allograft tendon appears to have similar outcomes regarding functional scores, return to play, and complication rates compared to autograft tendon. Use of allograft tendon seems to be a viable option for UCL reconstruction, though further studies are needed.