Varady Nathan H, Parise Suhas, Kunze Kyle N, Brusalis Christopher M, Williams Riley J, Altchek David W, Dines Joshua S
Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A..
Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A.
Arthroscopy. 2025 Jul;41(7):2297-2304.e1. doi: 10.1016/j.arthro.2024.10.049. Epub 2024 Nov 10.
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.
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.
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) 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 = .032). UCL repair remained associated with an increased risk of revision UCL surgery after adjusting for confounding variables (hazard ratio, 2.94; 95% confidence interval, 1.07-8.09; P = .037). Complication rates were similar between reconstruction and repair, including the incidence of ulnar neuropathy (13.8% vs 14.5%, P = .78).
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 III, retrospective cohort study.
在美国全国患者样本中，评估肘关节内侧尺侧副韧带（UCL）修复与重建术后翻修手术的风险。
这是一项回顾性队列研究，研究对象为2015年10月至2022年10月期间在一个大型全国数据库（PearlDiver）中因孤立性肘关节内侧UCL损伤接受初次UCL重建或修复的年轻患者（≤35岁）。收集患者人口统计学数据、合并症、手术细节以及伴随的尺神经手术情况。采用事件发生时间分析来评估两组之间UCL翻修手术的风险。还评估了两年并发症发生率，包括尺神经病变。
共有1820例患者（69.9%为重建，30.1%为修复）符合纳入标准，平均随访2.9年。UCL重建的估计2年无翻修生存率（95%置信区间）为99.5%（99.1%-99.9%），而UCL修复为97.9%（96.4%-99.3%）（未调整的对数秩检验P = 0.032）。在调整混杂变量后，UCL修复仍然与UCL翻修手术风险增加相关（风险比，2.94；95%置信区间，1.07-8.09；P = 0.037）。重建和修复之间的并发症发生率相似，包括尺神经病变的发生率（13.8%对14.5%，P = 0.78）。
在本研究中，我们发现在全国样本中，UCL修复与UCL重建相比，UCL翻修手术风险显著更高。然而，重要的是，总体失败率较低，且两种手术的并发症发生率相似。这些发现支持UCL修复的总体良好结果，同时表明它不一定是所有患者的最佳治疗方法。
III级，回顾性队列研究。
