Elbow Ulnar Collateral Ligament Reconstruction Using the Novel Docking Plus Technique in 324 Athletes

Abstract

BackgroundThis retrospective case series examined 324 athletes who received elbow ulnar collateral ligament (UCL) reconstruction by a single surgeon in a private practice over a 9-year period. The novel Docking Plus technique for elbow UCL reconstruction in 324 athletes provided good or excellent Conway score results in 88% of patients. The preponderance of previous studies examining UCL reconstruction outcomes were performed by surgeons at one of only three institutions (Andrews Institute, Hospital for Special Surgery, Kerlan Jobe Orthopedic Clinic).MethodsPatients undergoing UCL reconstruction from November 2005 to December 2014 were identified and contacted with a mailed survey and phone call. These patients were given a subjective 19 question survey assessing their outcomes from surgery.ResultsThe participants who responded to our survey were 90% male and 77% baseball players, 73% of which were pitchers. Of the baseball players who responded, 51.9% were in high school at the time of their surgery, 37% college, 6.5% minor leagues, and 2.2% in Major League Baseball. After surgery, 36% of survey responders returned to a higher level of competition than previously. For example, a high school athlete who had UCL reconstruction and went on to pitch in college. Further, 45% returned to the same level, and 7% returned to a lower level. Subjective “satisfaction,” was reported in 92% of responders and 97.2% reported that, “having surgery was a good idea.” Symptom onset in the responding athletes was 58.9% sudden, and 41.1% gradual. Overall, 90.9% of respondents returned to play in less than 1.5 years while 6.3% never were able to return. Re-tear occurred in 2.5% of patients, while 8.8% had subjective nerve dysfunction for at least 3 months following surgery.ConclusionThe Docking Plus technique can produce excellent subjective and objective results in athletes. Further study is warranted to see the effects of this procedure in other settings and determine which method of reconstruction or repair is superior.

Return-to-Sport Criteria After Upper Extremity Surgery in Athletes—A Scoping Review, Part 2: Ulnar Collateral Ligament of the Elbow Procedures

“…There was no consensus among the various studies as to how much time was adequate for rehabilitation before returning to play, with time frames ranging from 4 to 16 months; a minimum of 12 months between surgery and RTS was used as the Although various rehabilitation protocols were described in some of the technical and outcome studies that were reviewed for this study, actual RTS criteria remain critically underreported. 13,15 Time was the most commonly reported criterion, possibly due to the surgeons' estimated time for adequate tissue healing based on their personal experience; specifically, all of the included studies reported a minimum time and/or a range of time elapsed between surgery and RTS. Although time was the most commonly reported criterion, it seemed that other factors played a role in the decision to return the athletes to sport, and these factors should be reported in greater detail in future studies.…”

Choosing the appropriate measure of central tendency: mean, median, or mode?

“…The article states that the mean return to play timing is 16–20 months while the median return to play time is around 13 months. It is noted that the most likely reason for the discrepancy is a few extended and complicated cases that have a greater impact on mean calculations as compared to the median [2]. The mean is more greatly impacted by a few outliers, in this case abnormally long recovery times, and thus leads to an overestimate for the return to play timing which may affect a player’s decision of when to seek treatment or whether to pursue operative treatment at all.…”

Comparison of Ulnar Collateral Ligament Reconstruction Techniques in the Elbow of Sports Players

“…Bower et al [14] described another three-strand docking technique with excess graft sutured to the anterior band, while tension was maintained on the excess graft. McGraw et al [15] and Donohue et al [16,17] reported a novel docking plus technique that used four strands of the palmaris longus tendon.…”