Paper 20: Similar Clinical Outcomes Between Double Cortical Button and Docking Techniques for Ulnar Collateral Ligament Reconstruction in Baseball Players

Abstract

Objectives:

A double button technique using a cortical button on both the humeral and ulnar sides of the UCLR for fixation has recently been proposed, with advantages including greater control over graft tensioning and decreased risk of bone tunnel fracture. This double cortical button technique was recently evaluated biomechanically and found to be non-inferior to the traditional docking technique regarding strength, joint stiffness, and graft strain. However, clinical outcomes have not been compared between the double cortical button technique and standard UCLR techniques such as the docking technique. Therefore, the purpose of this study was to determine whether baseball players who underwent UCLR with a double cortical button (double button) technique have similar return to sport (RTS) rates, time to RTS, and subjective outcomes compared to baseball players who underwent UCLR with the traditional docking (Docking) technique.

Methods:

Competitive baseball players that underwent primary UCLR from 2011-2020 at across two institutions were identified using the CPT code 24346. Patients were excluded if they were not baseball players or if they did not undergo UCLR with the double button or docking technique. Included patients were contacted via RedCap to complete a follow-up survey evaluating reoperations, RTS, functional outcome scores, and patient satisfaction. Functional outcome surveys include the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway-Jobe score, Andrews-Timmerman (AT) elbow score, and the Single Assessment Numeric Evaluation (SANE) score.

Results:

Overall, 78 male baseball players (age: 18.9 ± 2.4 years) with an average follow-up of 3.1±2.4 years were evaluated, with 73 of the players being baseball pitchers and 55 (71%) of players completing the functional outcome surveys. Players in the double button group more frequently received palmaris longus autografts (78% vs. 30%) and less frequently received both gracilis autografts (22% vs. 58%) and allografts (0% vs. 13%) compared to players in the docking group (p=0.001); however, all other demographic factors were similar between groups (Table 1). All post-operative and patient-reported outcomes were also similar between groups. All players in the double button group (100%) were able to RTS in 11.1±2.6 months, while 96% of players in the docking group were able to RTS in 13.5±3.4 months (p>0.05). All other post-operative outcomes and patient-reported outcomes were statistically similar between groups, and remained similar after isolating pitchers only and after separating partial-thickness from full-thickness UCL tears (all p>0.05) (Tables 1-3). Two complications were observed in the docking group, with one player experiencing pain at elbow extension due to nerve neurolysis and another player developing an elbow stress fracture during rehabilitation, while no double button players experienced a complication.

Conclusions:

Post-operative outcomes were similar between baseball players who underwent UCLR with the double button technique and the docking technique. These findings provide the first clinical outcomes in support of a recent cadaveric study which showed the double button technique to provide similar elbow strength, joint stiffness, and graft strain compared to the docking technique. Larger comparative studies are necessary before a clear clinical recommendation can be made regarding the utilization of double button UCLR for baseball players.