Favorable Outcomes Following Elbow Ulnar Collateral Ligament Reconstruction and Repair, Though Repair Associated with Increased Risk of Revision Surgery.

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.