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

Abstract

Background: This 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).

Methods: Patients 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.

Results: The 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.

Conclusion: The 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.

Keywords: Baseball; Elbow; Ligament reconstruction; Tommy John Surgery; UCL.

Fig. 1

The Docking Plus Technique. a The bone tunnel locations within the proximal ulna and medial epicondyle of the humerus. b The graft is first passed through the ulnar tunnel, and the short end of the graft is sutured in a Krackow fashion; then, the suture ends are brought out the posterior exit holes of the medial epicondyle, while the graft is taken through the anterior exit holes. c The long end of the graft is then passed through the posterior medial epicondyle tunnel as the sutures are held at constant tension. d The graft is passed once again through the ulnar bone tunnels. e For the final pass, the graft is taken through the longitudinal tunnel of the medial epicondyle and out the anterior exit hole opposite the tensioned short end of the graft. f Both ends of the graft were then tensioned and tied together as the arm was held in a reduced position with no valgus stress at approximately 30° of flexion and the forearm in neutral rotation. (McGraw et al. 2013)

Fig. 2

Intraoperative photos. a Krakow stitch placement between short and long limbs, b tensioning of the 4-strand graft, and c figure-4 stitches placed between the 4-strands of the reconstruction and the remnant native UCL ligament

Fig. 3

Number of UCL reconstructions performed per year from 2006 to 2014

Fig. 4

UCL reconstruction patients by position

Fig. 5

Level of sports competition

Fig. 6

Level of return to play postoperatively

Fig. 7

Patient outcome measures