Ulnar collateral ligament repair and reconstruction have similar return to sport rates with low complication rates: a systematic review and meta-analysis.

Hypothesis and background: Ulnar collateral ligament (UCL) injuries are common in throwing athletes and occur when valgus force at the elbow surpasses the ligament's maximum load capacity. The purpose of this systematic review and meta-analysis was to evaluate return-to-sport (RTS) rates and complications following UCL repair vs. UCL reconstruction. We hypothesized that both types of UCL operative interventions are safe and effective, with comparable RTS rates and acceptably low complication rates. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, and Cochrane Library databases were searched in July 2024 for studies published after 2000. Studies were included if they evaluated athletes of any sport and level of competition who underwent UCL repair or UCL reconstruction and reported RTS rates or complication rates with a minimum of 1 year of follow-up time. Data from each study were pooled with the DerSimonian-Laird random-effects model. Results: The initial screen identified 2718 studies, 31 of which were included in this systematic review and meta-analysis. Each study had a noncomparative study design with similar demographics, low heterogeneity, and sufficiently low risk of bias. A total of 496 patients underwent UCL repair, and 2277 patients underwent UCL reconstruction. UCL repair and reconstruction both had high rates of RTS, with 91.1% of UCL repair patients RTS (95% confidence interval: 87.0%-95.2%) and 88.7% of UCL reconstruction patients RTS (95% confidence interval: 85.7%-91.7%). Ulnar neuritis was reported in 0.9% of UCL repair patients (95% confidence interval: -0.9% to 2.7%) and 5.1% of UCL reconstruction patients (95% confidence interval: 1.3%-9.0%). There were low graft failure rates, with 1.0% in the repair cohort (95% confidence interval: 0.1%-1.9%) and 1.2% in the reconstruction cohort (95% confidence interval: 0.4%-1.7%). Reoperations were observed in 3.0% (95% confidence interval: 1.4%-4.6%) of repair patients and 5.1% (95% confidence interval: 2.7%-7.6%) of reconstruction patients. Discussion and conclusion: Although UCL repair is only feasible in specific instances of partial injury, both UCL repair and UCL reconstruction are effective procedures that enable athletes to RTS at a high rate with low associated complications. Surgeons should base operative decision making based on patient sport and level of competition to optimize RTS and minimize complication and reinjury risk.