Direct Comparison of Modified Jobe and Docking Reconstructions With Ulnar Collateral Ligament Repair With Suture Augmentation at Midterm Follow-up

Abstract

Background:

The modified Jobe and docking techniques are the most utilized ulnar collateral ligament (UCL) reconstruction techniques, with previous research demonstrating successful and equivalent outcomes at midterm follow-up. However, these techniques have not been compared with UCL repair with suture augmentation (SA), nor has longer-term follow-up been reported.

Purpose:

To directly compare clinical outcomes at midterm follow-up of these 3 surgical techniques: the modified Jobe, docking, and repair with SA.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Twenty-four surgical procedures for UCL repair with SA were performed by a single surgeon, each with a minimum 2-year follow-up. Patients were matched by age, gender, and handedness to patients from previously published modified Jobe and docking cohorts. The following were compared among groups: Conway Scale, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score, years played, gender, handedness, sport, position, graft type (for reconstructive techniques), future upper extremity injury, need for additional surgery, rates of ulnar nerve symptoms, and return-to-play time.

Results:

Patients were similar with respect to age (P = .54), gender (P = .66), handedness (P = .29), sport (P = .23), years played (P = .72), level of competition (P = .08), type of pathology (P = .23), future shoulder surgery (P = .71), and future elbow surgery (P = .61). The mean ± SD follow-up was 6.2 ± 3.9, 7.3 ± 4.6, and 5.2 ± 1.1 years in the modified Jobe, docking, and repair + SA groups, respectively (P = .66). The reconstruction groups had a greater proportion of pitchers than the repair + SA group (P = .02). Tear locations in the SA cohort were proximal in 18 (75%) and distal in 6 (25%). In the SA cohort, 13 (54%) were partial tears, 10 (42%) were complete tears, and 1 (4%) was attenuated. The repair + SA cohort had a significantly greater proportion of proximal tears than the docking cohort (P = .03). No difference was identified among techniques in results on the Kerlan-Jobe Orthopaedic Clinic score (P = .70) or Conway Scale (P = .06). The UCL repair + SA cohort returned to sports 4 months earlier than the reconstruction cohorts (P = .0001).

Conclusion:

No differences in outcomes scores or return-to-play rates were found when the modified Jobe and docking UCL reconstruction techniques were compared with the UCL repair + SA technique at >5-year mean follow-up; however, the SA group returned to sport 4 months earlier on average. Given the similar outcomes among groups, all 3 techniques are viable treatment options for UCL injuries.