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Are Suture Spanning Repair Techniques Replacing Traditional Tommy John Surgery? Prevalence and Complication Rates
Mitchell H Negus1, Matthew E Guareschi1, Lauren Wohlrab1
1Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, Charleston, South Carolina, USA.
Background:
Ulnar collateral ligament (UCL) reconstruction has historically been considered the gold standard treatment for severe UCL tears. With the advent of suture-spanning repair techniques, some studies suggest that UCL repair is being performed with increasing frequency. This study provides a large analysis of UCL reconstruction versus repair trends in the United States following the introduction of suture-spanning repair techniques.
Purpose:
To compare the prevalence and complication rates of UCL reconstruction versus repair over a 5-year span following the introduction of suture spanning repair techniques. We also sought to determine if there was an age-related preference for reconstruction versus repair and whether the addition of an ulnar nerve transposition (UNT) affected short-term complication rates.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Using the Merative MarketScan research databases, which contain deidentified patient national claims information, we retrospectively identified patients aged 14 to 30 years who underwent UCL reconstruction or repair between 2016 and 2021, with or without UNT. Patients with a fracture diagnosis at the time of surgery were excluded. Demographic information including age, sex, and geographic region was collected. The number of patients who experienced infection, ulnar neuropathy, device-related complications, and unspecified complications were obtained for each procedure.
Results:
A total of 1191 reconstruction patients and 696 repair patients were identified. 36.8% of patients who underwent either reconstruction or repair had a concomitant UNT. UCL reconstruction patients were approximately 3 years older than repair patients on average (P < .001). Male patients accounted for 89.5% of reconstruction patients and 77.7% of repair patients. From 2016 to 2021, the number of reconstructions declined 32.0% and the number of repairs increased 81.6%. There were no differences in the rate of infection (P = .36) and ulnar neuropathy (P = .73) between reconstruction and repair. The overall risk of developing any complication was higher for repair patients (1.58%) than reconstruction patients (0.67%); however, this difference was not significant (P = .09).
Conclusion:
Between 2016 and 2021, following the introduction of suture spanning UCL repair techniques, the number of UCL repairs increased and the number of reconstructions decreased. There was no difference in complication rates between UCL repair and UCL reconstruction and the rate of complication for either surgery remains low.