Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
Zucker School of Medicine/Northwell at Northshore and Long Island Jewish, Manhasset, New York, U.S.A.
Arthroscopy. 2024 Apr;40(4):1343-1355.e1. doi: 10.1016/j.arthro.2023.09.030. Epub 2023 Oct 11.
To systematically review (1) biomechanical properties of augmented elbow ulnar collateral ligament (UCL) repair compared with reconstruction and (2) clinical efficacy and complication rates of UCL repair with and without augmentation.
A systematic review was completed August 15, 2023, identifying articles that (1) biomechanically compared suture augmented UCL repair and reconstruction and (2) clinically evaluated medial elbow UCL repairs. Search terms included: "UCL repair" OR "internal brace" OR "suture augmentation" AND "UCL reconstruction." For inclusion, biomechanical studies compared augmented repair with reconstruction; clinical studies required clinical outcomes with minimum 6-month follow-up. Biomechanical data included torsional stiffness, gap formation, peak torque, and failure torque. Clinical data included return to previous level of play, time to return, functional outcomes, and complications.
In total, 8 biomechanical and 9 clinical studies were included (5 with and 4 without augmentation). In most biomechanical studies, augmented repairs demonstrated less gap formation, with equivalent torsional stiffness, failure load, and peak torque compared with reconstruction. Clinical outcomes in 104 patients without augmentation demonstrated return to previous level of 50% to 94% for nonprofessional athletes and 29% for professional baseball pitchers. Suture augmented repairs in 554 patients demonstrated return to previous level from 92% to 96%, at 3.8 to 7.4 months, with Kerlan Jobe Orthopaedic Clinic scores of 86 to 95. The overall complication rate for augmented UCL repair was 8.7%; most commonly ulnar neuropraxia (6%).
Biomechanically, UCL repair with augmentation provided less gapping with equivalent torsional stiffness and failure compared with reconstruction. Clinically, augmented UCL repair demonstrated excellent return to previous level of play and Kerlan Jobe Orthopaedic Clinic scores with modest complications and time to return. Augmented UCL repair is biomechanically equivalent to reconstruction and may be a viable alternative to reconstruction in indicated athletes.
UCL repair with suture augmentation is biomechanically equivalent to reconstruction and clinically demonstrates excellent outcomes.
系统回顾（1）增强型肘尺侧副韧带（UCL）修复与重建的生物力学特性，以及（2）UCL 修复与不修复的临床疗效和并发症发生率。
2023 年 8 月 15 日完成系统回顾，确定了（1）生物力学上比较缝合增强 UCL 修复与重建的文章，以及（2）临床评估内侧肘 UCL 修复的文章。搜索词包括：“UCL 修复”或“内部支撑”或“缝合增强”和“UCL 重建”。纳入标准为：生物力学研究比较了增强修复与重建；临床研究需要至少 6 个月随访的临床结果。生物力学数据包括扭转刚度、间隙形成、峰值扭矩和失效扭矩。临床数据包括恢复到以前的运动水平、恢复时间、功能结果和并发症。
共纳入 8 项生物力学研究和 9 项临床研究（5 项有增强，4 项无增强）。在大多数生物力学研究中，增强修复的间隙形成较少，扭转刚度、失效负荷和峰值扭矩与重建相当。104 例无增强患者的临床结果显示，非职业运动员中有 50%至 94%恢复到以前的运动水平，职业棒球投手有 29%恢复到以前的运动水平。在 554 例接受缝合增强修复的患者中，有 92%至 96%的患者在 3.8 至 7.4 个月内恢复到以前的运动水平，Kerlan Jobe 矫形诊所评分为 86 至 95。增强 UCL 修复的总体并发症发生率为 8.7%；最常见的是尺神经麻痹（6%）。
生物力学上，增强 UCL 修复的间隙形成较少，扭转刚度和失效与重建相当。临床上，增强 UCL 修复在恢复到以前的运动水平和 Kerlan Jobe 矫形诊所评分方面表现出色，并发症和恢复时间适中。增强 UCL 修复在生物力学上与重建相当，在适当的运动员中可能是重建的可行替代方案。
带缝线增强的 UCL 修复在生物力学上与重建相当，在临床上表现出优异的效果。
