Rothman Orthopaedic Institute, Philadelphia, PA, USA; Hackensack Meridian School of Medicine, Nutley, NJ, USA.
Georgetown University School of Medicine, Washington DC, USA.
J Shoulder Elbow Surg. 2024 Feb;33(2):366-372. doi: 10.1016/j.jse.2023.07.045. Epub 2023 Sep 7.
A double cortical button technique for ulnar collateral ligament reconstruction (UCLR) has advantages including significant control over graft tensioning, less concern about graft length, and minimized risk of bone tunnel fracture compared with traditional UCLR techniques. This double cortical button technique was recently found to be noninferior in mechanical performance to the traditional docking technique regarding joint strength, joint stiffness, and graft strain. However, clinical outcomes have not been compared between these UCLR techniques. Therefore, the purpose of this study was to determine whether baseball players who underwent UCLR with a double cortical button (double button) technique have similar return-to-sport (RTS) outcomes to baseball players who underwent UCLR with the traditional docking (docking) technique.
Baseball players who underwent primary UCLR from 2011 to 2020 across 2 institutions were identified. Included patients were contacted to complete a follow-up survey evaluating reoperations, RTS, and functional outcome scores. Functional outcome surveys include the Kerlan-Jobe Orthopaedic Clinic score, the Conway-Jobe score, the Andrews-Timmerman elbow score, and the Single Assessment Numeric Evaluation score.
Overall, 78 male baseball players (age: 18.9 ± 2.4 years) with an average follow-up of 3.1 ± 2.4 years were evaluated, with 73 of the players being baseball pitchers. Players in the double button group more frequently received palmaris longus autografts (78% vs. 30%) and less frequently received gracilis autografts (22% vs. 58%) compared with players in the docking group (P = .001); however, all other demographic factors were similar between the groups. All players in the double button group were able to RTS in 11.1 ± 2.6 months, whereas 96% of players in the docking group were able to RTS in 13.5 ± 3.4 months (P > .05). All postoperative outcomes and patient-reported outcomes were statistically similar between the groups and remained similar after isolating pitchers only and after separating partial-thickness from full-thickness UCL tears (all P > .05).
RTS and other postoperative outcomes may be similar between baseball players who underwent UCLR with the double button technique and the docking technique. Although future research may be necessary to strengthen clinical recommendations, these findings provide the first clinical outcomes in light of a recent cadaveric study finding similar elbow strength, joint stiffness, and graft strain compared with the docking technique.
与传统的 UCLR 技术相比，双皮质纽扣技术在重建尺侧副韧带 (UCLR) 方面具有优势，包括对移植物张力的有效控制、对移植物长度的担忧较小以及骨隧道骨折的风险最小化。最近发现，这种双皮质纽扣技术在关节强度、关节刚度和移植物应变方面与传统的对接技术相比，在机械性能上无差异。然而，这些 UCLR 技术的临床结果尚未进行比较。因此，本研究的目的是确定接受双皮质纽扣（双纽扣）技术 UCLR 的棒球运动员与接受传统对接（对接）技术 UCLR 的棒球运动员的重返运动（RTS）结果是否相似。
确定了 2011 年至 2020 年在 2 家机构接受 UCLR 的棒球运动员。联系纳入的患者完成随访调查，评估再次手术、RTS 和功能结果评分。功能结果调查包括 Kerlan-Jobe 骨科诊所评分、Conway-Jobe 评分、Andrews-Timmerman 肘部评分和单评估数字评估评分。
总体而言，评估了 78 名男性棒球运动员（年龄：18.9±2.4 岁），平均随访 3.1±2.4 年，其中 73 名运动员为棒球投手。与对接组相比，双纽扣组更频繁地接受掌长肌自体移植物（78%比 30%），较少接受骼胫束自体移植物（22%比 58%）（P=.001）；然而，两组的所有其他人口统计学因素均相似。双纽扣组的所有运动员均能在 11.1±2.6 个月时 RTS，而对接组的 96%的运动员能在 13.5±3.4 个月时 RTS（P>.05）。双纽扣组和对接组的所有术后结果和患者报告的结果在统计学上均相似，在仅分离投手后以及在分离部分厚度与全厚度 UCL 撕裂后，结果仍相似（均 P>.05）。
接受双纽扣技术和对接技术 UCLR 的棒球运动员的 RTS 和其他术后结果可能相似。尽管可能需要进一步的研究来加强临床建议，但这些发现提供了在最近的尸体研究发现与对接技术相比，肘部强度、关节刚度和移植物应变相似的情况下的首次临床结果。
