Medial Ulnar Collateral Ligament Reconstruction Using Internal Bracing: A Meta-Analysis of Biomechanical Studies

The purpose of this systematic review and meta-analysis was to evaluate human biomechanical studies investigating ulnar collateral ligament reconstructions using an internal brace mechanical augment construct. A search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in August 2025 across the PubMed, Cochrane, and Web of Science databases to identify studies reporting biomechanical outcomes of ulnar collateral ligament reconstructions in isolation compared to ulnar collateral ligament reconstruction with an internal brace. A total of 329 studies were reviewed, with 6 studies meeting inclusion criteria. Data on ultimate failure torque (Nm), stiffness (Nm/deg), ulnohumeral gapping (mm), and valgus laxity (deg) were extracted. A meta-analysis comparing these four biomechanical parameters was conducted using a systematic review, a random-effects model, and pooled standardized mean differences. For ultimate failure torque, the pooled standardized mean difference was 1.54 (95% confidence interval: - 0.28 to 3.35, p=0.074), trending towards higher torque strength for the internal brace. For graft stiffness, the pooled standardized mean difference was 0.91 (95% confidence interval: - 0.17 to 1.99, p=0.068), trending towards higher stiffness for the internal brace constructs. For ulnohumeral gapping, the pooled standardized mean difference was - 0.52 (95% confidence interval: - 1.01 to-0.03, p=0.043), indicating a statistically significant effect of less gapping for the internal brace. Internal brace augmentation resulted in decreased ulnohumeral gapping and demonstrated favorable biomechanical trends compared with traditional ulnar collateral ligament reconstruction, suggesting improved early construct stability.