Return-to-Sport Outcomes After Primary Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Tendon Grafts: A Systematic Review

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2021 Dec 9

PMID 34881347

Citations 6

Authors

David P Trofa

Michael Constant

Connor R Crutchfield

Nicholas J Dantzker

Bryan M Saltzman

T Sean Lynch

Christopher S Ahmad

Affiliations

Soon will be listed here.

Abstract

Background: Ulnar collateral ligament (UCL) reconstruction is the current gold standard of treatment for overhead athletes with a symptomatic, deficient UCL of the elbow who have failed nonoperative treatment and wish to return to sport (RTS) at a high level. The palmaris longus and hamstring tendons are common graft choices, but no study has analyzed the existing literature to assess whether one graft is superior to the other.

Purpose: To systematically report on the outcomes of UCL reconstruction using palmaris and hamstring autografts.

Study Design: Systematic review; Level of evidence, 4.

Methods: A combination of the terms "ulnar collateral ligament," "valgus instability," "Tommy John surgery," "hamstring," and "palmaris longus" were searched in PubMed, Embase, and the Cochrane Library. RTS and return-to-same-level (RSL) rates, patient-reported outcomes, and complications were included for analysis. We used the modified Coleman Methodology Score and risk-of-bias tool for nonrandomized studies to assess the quality of the included studies.

Results: This review included 6 studies (combined total of 2154 elbows) that directly compared palmaris and hamstring graft use in UCL reconstruction. Follow-up ranged from 24 to 80.4 months, and the mean patient age across all studies was 21.8 years. The mean RSL across all studies and grafts was 79.0%, and the mean RTS was 84.1%, consistent with results previously reported in the literature. The mean RTS and RSL rates for the palmaris graft group were 84.6% and 82%, respectively; the hamstring graft group showed mean RTS and RSL rates of 80.8% and 80.8%. Meta-analysis revealed no significant difference in RSL between the 2 graft groups (odds ratio, 1.06; 95% CI, 0.77-1.46). The combined complication rate of the included studies was 18.2%, with failure rates ranging from 0% to 7.1%.

Conclusion: Results of this review indicated that both palmaris and hamstring tendon grafts are viable options for primary UCL reconstruction. Graft choice should be determined by a combination of patient and surgeon preference.

Citing Articles

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Nagy B, Alexander J, Liu J J Orthop. 2024; 64:1-6.

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Shaari A, Fano A, Anakwenze O, Klifto C Shoulder Elbow. 2024; 16(4):429-435.

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Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction Between Palmaris Longus Autograft and Knee Medial Collateral Ligament Allograft.

Stone M, Chao L, Huang D, Parikh H, Sun M, Kulber D Orthop J Sports Med. 2024; 12(3):23259671241234685.

PMID: 38524888 PMC: 10958818. DOI: 10.1177/23259671241234685.

Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-Analyses of Ulnar Collateral Ligament Reconstruction.

Thompson A, Mayfield C, Bashrum B, Abu-Zahra M, Petrigliano F, Liu J Arthrosc Sports Med Rehabil. 2023; 5(6):100808.

PMID: 37965531 PMC: 10641735. DOI: 10.1016/j.asmr.2023.100808.

Biomechanical Properties of Knee Medial Collateral Ligament Compared to Palmaris Longus for Ulnar Collateral Ligament Reconstruction.

Huang D, Foster L, Stone M, Kulber D, Metzger M Ann Biomed Eng. 2023; 51(8):1795-1801.

PMID: 37076695 PMC: 10326149. DOI: 10.1007/s10439-023-03188-z.

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