Abstract
Objectives:
To examine the epidemiological trends of UCL repair with an internal brace compared to UCL reconstruction on a state-wide level over a 5-year period. The primary endpoints were the yearly rates of UCL repairs and reconstructions. Secondary endpoints included patient demographics, institutional and surgeon volumes, and concomitant ulnar nerve transposition.
Methods:
In this descriptive epidemiological study, the New York Statewide Planning and Research Cooperative System (SPARCS) database contains information for every New York State ambulatory discharge. The database was queried to obtain all UCL repairs and reconstructions in New York State from 2017 to 2021, utilizing outpatient CPT-4 (Current Procedural Terminology, 4th Revision) codes. Data obtained included concomitant ulnar nerve surgery, patient age, sex, ethnicity, insurance, laterality, as well as institutional and surgeon volume.
Results:
From 2017 to 2021, there were 745 UCL surgeries performed in New York State. From 2017 to 2021, there was a 48% increase in UCL reconstructions in the state, compared to an even greater increase in incidence of UCL repairs during this time at 133%. In 2017, UCL repairs accounted for 26% of all UCL surgeries in the state. By 2021, UCL repairs had risen to account for 38% of all UCL surgeries. From 2017 to 2021, the total incidence of UCL surgeries increased by 72%, with an increased incidence of concomitant ulnar nerve surgery of 74%. Amongst patients 13 to 16 years of age, repairs accounted for 40% of UCL surgeries, compared to just 23.3% of UCL surgeries amongst patients 21 to 25 years of age. The two New York highest volume surgeons performed a 543% increase in UCL surgeries (16 in 2017 to 87 in 2021). UCL reconstruction was favored over repair by the two highest volume New York surgeons, though repair incidence increased over the years. There was an increased percent of UCL surgeries with concomitant ulnar nerve transposition, from 31% in 2017 to 43% in 2021.
Conclusions:
While the frequency of UCL reconstruction in New York State has risen in recent years, the frequency of UCL repair with an internal brace has risen at an even faster rate. UCL repairs are growing more common amongst younger patients. Amongst the two highest volume UCL surgeons in New York State, UCL reconstruction is heavily favored over repair with an internal brace, though repair incidence has increased over the years. There is a paradigm shift underway towards UCL repair with an internal brace, though the highest volume UCL surgeons still favor UCL reconstruction.
