Elbow UCL repair with suture augmentation is biomechanically equivalent to reconstruction and clinically demonstrates excellent outcomes: a systematic review.
Elbow UCL repair with suture augmentation is biomechanically equivalent to reconstruction and clinically demonstrates excellent outcomes: a systematic review. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2023Abstract
PURPOSE: The purpose of the study was to systematically review (1) biomechanical properties of augmented elbow ulnar collateral ligament (UCL) repair compared to reconstruction, and (2) clinical efficacy and complication rates of UCL repair with and without augmentation.METHODS: A systematic review was completed August 15, 2023, identifying articles that (1) biomechanically compared suture augmented UCL repair and reconstruction, and (2) clinically evaluated medial elbow UCL repairs. Search terms included: "UCL repair" OR "internal brace" OR "suture augmentation" AND "UCL reconstruction". For inclusion, biomechanical studies compared augmented repair to reconstruction; clinical studies required clinical outcomes with minimum 6-month follow-up. Biomechanical data included torsional stiffness, gap formation, peak torque, and failure torque. Clinical data included return to previous level of play, time to return, functional outcomes, and complications.RESULTS: Eight biomechanical and 9 clinical studies were included (5 with and 4 without augmentation). In most biomechanical studies, augmented repairs demonstrated less gap formation, with equivalent torsional stiffness, failure load, and peak torque compared to reconstruction. Clinical outcomes in 104 patients without augmentation demonstrated return to previous level of 50-94% for non-professional athletes and 29% for professional baseball pitchers. Suture augmented repairs in 554 patients demonstrated return to previous level from 92-96%, at 3.8-7.4 months, with KJOC scores of 86-95. The overall complication rate for augmented UCL repair was 8.7%; most commonly ulnar neuropraxia (6%).CONCLUSION: Biomechanically, UCL repair with augmentation provided less gapping with equivalent torsional stiffness and failure compared to reconstruction. Clinically, augmented UCL repair demonstrated excellent return to previous level of play and KJOC scores with modest complications and time to return. Augmented UCL repair is biomechanically equivalent to reconstruction and may be a viable alternative to reconstruction in indicated athletes.
View details for DOI 10.1016/j.arthro.2023.09.030
View details for PubMedID 37832744