Favorable Outcomes Following Elbow Ulnar Collateral Ligament Reconstruction and Repair, Though Repair Associated with Increased Risk of Revision Surgery.
Nathan H Varady, Suhas Parise, Kyle N Kunze, Christopher M Brusalis, Riley J Williams, David W Altchek, Joshua S Dines
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引用次数: 0
Abstract
Purpose: To assess the risk of revision surgery following repair versus reconstruction of the medial ulnar collateral ligament (UCL) of the elbow in a national sample of patients in the United States.
Methods: This was a retrospective cohort study of young patients (≤35 years old) who underwent primary UCL reconstruction or repair for an isolated medial UCL injury of the elbow from October 2015 through October 2022 in a large national database (PearlDiver). Patient demographic data, comorbidities, surgical details, and concomitant ulnar nerve procedures were collected. Time-to-event analyses were used to assess the risk of revision UCL surgery between groups. Two-year complication rates, including ulnar neuropathy, were also assessed.
Results: In total, 1,820 patients (69.9% reconstruction, 30.1% repair) with an average follow-up of 2.9 years met inclusion criteria. The estimated 2-year revision-free survival (95% confidence interval [CI]) was 99.5% (99.1%-99.9%) for UCL reconstruction compared to 97.9% (96.4%-99.3%) for UCL repair (unadjusted Log-rank p=0.032). UCL repair remained associated with an increased risk of revision UCL surgery after adjusting for confounding variables (hazard ratio 2.94, 95% CI 1.07-8.09, p=0.037). Complication rates were similar between reconstruction and repair, including the incidence of ulnar neuropathy (13.8% vs. 14.5%, p=0.78).
Conclusion: In this study, we found that UCL repair was associated with a significantly higher risk of revision UCL surgery than UCL reconstruction in a national sample. Importantly, however, overall failure rates were low and complication rates were similar between procedures. These findings support the overall favorable outcomes of UCL repair, while suggesting it may not necessarily be the optimal treatment for all patients.
Level of evidence: 3 - retrospective cohort study.
目的：在美国全国样本患者中评估肘部内侧尺侧韧带（UCL）修复与重建后进行翻修手术的风险：这是一项回顾性队列研究，研究对象是2015年10月至2022年10月期间在大型国家数据库（PearlDiver）中因孤立的肘部内侧尺侧韧带损伤而接受初级UCL重建或修复手术的年轻患者（≤35岁）。该数据库收集了患者的人口统计学数据、合并症、手术细节以及同时进行的尺神经手术。采用时间到事件分析法来评估不同组间进行 UCL 手术的风险。同时还评估了两年的并发症发生率，包括尺神经病变：共有1820名患者（69.9%为重建，30.1%为修复）符合纳入标准，平均随访时间为2.9年。UCL重建术的估计2年无翻修生存率（95%置信区间[CI]）为99.5%（99.1%-99.9%），而UCL修复术的估计2年无翻修生存率为97.9%（96.4%-99.3%）（未经调整的Log-rank p=0.032）。调整混杂变量后，UCL修复术仍与UCL翻修手术风险增加有关（危险比2.94，95% CI 1.07-8.09，p=0.037）。重建与修复的并发症发生率相似，包括尺神经病变的发生率（13.8% vs. 14.5%，p=0.78）：在这项研究中，我们发现在全国样本中，UCL修复术与UCL翻修手术相关的风险明显高于UCL重建术。但重要的是，不同手术的总体失败率较低，并发症发生率相似。这些发现支持了UCL修复术的总体良好结果，同时也表明它不一定是所有患者的最佳治疗方法：3--回顾性队列研究。
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