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

Autor:	Varady NH; Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A.. Electronic address: nhvarady@gmail.com., Parise S; Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A., Kunze KN; Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A., Brusalis CM; Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A., Williams RJ 3rd; Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A., Altchek DW; Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A., Dines JS; Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A.
Jazyk:	angličtina
Zdroj:	Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2024 Nov 10. Date of Electronic Publication: 2024 Nov 10.
DOI:	10.1016/j.arthro.2024.10.049
Abstrakt:	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) 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). Conclusions: 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: Level III, retrospective cohort study. Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: N.H.V. and K.N.K. are on the Editorial Board of Arthroscopy. R.J.W. has stock or stock options with BICMD, Cymedica, Engage Surgical, Gramercy Extremity Orthopedics, Pristine Surgical, and RecoverX; is a paid consultant for Arthrex, JRF Ortho, and Lipogems; receives IP royalties from Arthrex; and receives research support from Histogenics; D.W.A. is a paid consultant for Arthrex and Stryker. J.S.D. is a board or committee member of the American Shoulder and Elbow Surgeons, receives IP royalties from Arthrex and Linvatec, is a paid consultant or paid presenter or speaker and receives research support from Arthrex, is on the editorial or governing board for the Journal of Shoulder and Elbow Surgery, receives publishing royalties or financial or material support from Thieme and Wolters Kluwer Health, and has stock or stock options with ViewFi. All other authors (S.P., C.M.B.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu