Summary

In this national sample of 1,820 patients, UCL repair was associated with slightly increased risk of revision UCL surgery compared to UCL reconstruction.

Abstract

Introduction

While reconstruction is the historical gold standard surgical treatment of medial ulnar collateral ligament (UCL) injuries of the elbow, there is growing interest in UCL repair as an alternative surgical option. To date, there are no clinical data comparing the risk of revision surgery following UCL reconstruction and repair. Therefore, the purpose of this study was to assess the long-term results of UCL repair and reconstruction in a national sample of patients in the United States. We hypothesized that revision risk would be similar between UCL reconstruction and UCL repair.

Methods

This was a retrospective cohort study of young patients (≤35 years old) who underwent primary UCL reconstruction or repair for an isolated medial UCL injury of the elbow from October 2015 through October 2022 in a large national database. Patient demographic data, comorbidities, surgical details, and concomitant ulnar nerve procedures were collected. Time-to-event analyses (i.e., Kaplan-Meier curves for unadjusted analysis and Cox-proportional hazard models for adjusted analysis) were used to assess the risk of revision UCL surgery between groups. Two-year complication rates were also assessed.

Results

In total, 1,820 patients (69.9% reconstruction, 30.1% repair) with an average follow-up of 2.9 years met inclusion criteria. The estimated 2-year revision-free survival (95% confidence interval [CI]) was 99.5% (99.1%-99.9%) for UCL reconstruction compared to 97.9% (96.4%-99.3%) for UCL repair (unadjusted Log-rank p=0.032). UCL repair remained associated with an increased risk of revision UCL surgery after adjusting for confounding variables (hazard ratio 2.94, 95% CI 1.07-8.09, p=0.037). Complication rates, including postoperative ulnar neuropathy (13.8% for UCL reconstruction vs. 14.5% for UCL repair, p=0.78), were similar between groups.

Discussion

UCL repair has emerged as a viable treatment for UCL injuries in certain patients. In this study, we found that UCL repair was associated with a significantly higher risk of revision UCL surgery than UCL reconstruction in a national sample. Importantly, however, overall failure rates were low and complication rates were similar between procedures. These findings support the overall favorable outcomes of UCL repair, while suggesting that further study may be needed to delineate ideal indications for its use.