Abstract
Objectives:
Injury of the ulnar collateral ligament (UCL) has become increasingly common, particularly in overhead athletes. There is no consensus on management of the ulnar nerve in UCL reconstruction (UCLR) in patients with pre-operative ulnar nerve symptoms, as literature supports both not decompressing the nerve as well as ulnar nerve transposition (UNT). The purpose of this study is to compare subjective clinical outcomes and return to play metrics between patients who received UNT during UCLR and a matched cohort who underwent UCLR alone. We hypothesized that there would be no significant difference in patient outcomes or return to sport (RTS) metrics between the cohorts.
Methods:
Using an institutional database, patients who underwent UCLR with UNT between 2007 and 2017 were retrospectively identified. These patients were matched based on sex, age at surgery (± 3 years), and BMI (± 2) to a comparison group that underwent UCLR alone. Patients completed the Kerlan Jobe Orthopaedic Clinic Shoulder & Elbow score (KJOC), the Timmerman and Andrews elbow score, the Conway-Jobe scale, and custom patient satisfaction and return to play questionnaires.
Results:
Thirty patients who underwent UCLR with concomitant UNT and 30 matched patients who underwent UCLR without UNT were available for follow up at a mean of 6.9 and 8.1 years respectively. The UNT group reported similar KJOC (78.4 in UNT vs 76.8; P=0.780), Conway-Jobe (60% excellent in UNT vs 77% excellent; P=0.504), Timmerman and Andrews (86.2 in UNT vs. 88.8; P=0.496), and satisfaction scores (85.3% in UNT vs. 89.3%; P=0.512) compared to UCLR group. In terms of RTS rate (84% in UNT vs 93%; P=0.289) and duration required to RTS (11.1 months in UNT vs 12.5 months; P=0.176), the two groups did not significantly differ. Finally, despite significant differences in preoperative ulnar nerve symptoms (100% in UNT vs 7% in UCLR; P<0.001), the two groups did not statistically differ in the proportion of patients that experienced post-operative ulnar nerve symptoms (13% in UNT vs 0%; P=0.112)
Conclusions:
This matched cohort analysis showed no statistically significant differences in patient reported outcomes and return to sport between patients undergoing UCLR with and without UNT.
