Abstract
Objectives:
The modified Jobe and Docking techniques are the most utilized ulnar collateral ligament (UCL) reconstruction techniques with prior research demonstrating successful and equivalent outcomes at midterm follow-up. More recently, UCL repair augmented with the Internal Brace (IB) has been investigated as a possible alternative with cadaveric studies demonstrating improved time-zero biomechanics and favorable clinical results at early follow-up, with possible earlier return to play. However, there has been no comparison between UCL repair with IB and these reconstruction techniques, nor has longer term follow-up been reported. The purpose of this study was to directly compare clinical outcomes at mid-term follow-up of these three surgical techniques: the modified Jobe, Docking, and repair with IB when performed by a single surgeon.
Methods:
Nineteen UCL repair with IB surgical procedures 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. Conway Scale, Kerlan-Jobe Orthopaedic Clinic (KJOC) score, years played, gender, handedness, sport, position, graft type (for reconstructive techniques), future upper extremity injury, and need for additional surgery were compared between groups.
Continuous variables are displayed as mean ± standard deviation unless otherwise indicated, with groups compared using a Kruskal-Wallis test. Categorical variables are displayed as count (percentage total), with pairwise comparison between groups performed using a Fisher’s exact test. When there were greater than 2 categorical variables, groups were compared with chi square test for trend. For multiple comparisons of categorical variables, the lowest P value is shown in Tables 1 and 2, with no comparison reaching P < 0.05, which was considered significant.
Results:
Patients were similar with respect to age (p=0.52), gender (p>0.60), handedness (p>0.17), sport (p>0.16), position (p>0.07), years played (p=0.69), level of competition (p>0.26), future shoulder surgery (p>0.65), and future elbow surgery (p>0.48) (Table 1). The mean follow-up was 5.7 ± 3.5 years, 7.4 ± 4.7 years, and 5.4 ± 1.2 years in the modified Jobe, Docking, and repair with IB groups, respectively (p=0.55). No difference was identified between techniques in KJOC scores (modified Jobe, 73.5 ± 23.6; Docking, 74.5 ± 25.5; repair with IB, 75.5 ± 25.3) or Conway Scale (return to play, any level: 73% vs. 84% vs.78%, p>0.11) (Table 2).
Conclusions:
No differences in outcomes scores or return to play were found when the modified Jobe and Docking UCL reconstruction techniques were compared with the UCL repair with internal brace technique at greater than 5-year average follow-up. Given the similar outcomes between groups, all three techniques are viable treatment options for UCL injuries. Sufficient clinical equipoise exists in surgical decision making, with repair being a durable option in the proper patient.
