Published 6/1/2020
Kerri Fitzgerald

Allograft MUCL Reconstruction Beneficial Even in Nonathletes

Editor’s note: The following content was published in the AAOS Now Special Edition and distributed in June 2020. The content was originally scheduled for the AAOS Now Daily Edition, which publishes each year onsite at the AAOS Annual Meeting but this year’s meeting in March was canceled due to COVID-19. Despite the cancellation, members can access virtual content from the Annual Meeting by visiting the Academy’s Annual Meeting Virtual Experience webpage.

There are vast data on the use of medial ulnar collateral ligament (MUCL) reconstruction in young athletes; however, limited information exists on nonathlete patients seeking functional elbow outcomes. A recent study found that following failure of nonsurgical treatments, MUCL allograft reconstruction in nonelite athletes and average workers has a low rate of recurrent instability and provides good functional outcomes.

The researchers said the functional scores were comparable to many previously reported autograft outcomes in elite athletes. Erick Marigi, MD, an orthopaedic surgery resident physician at Mayo Clinic, presented the study as part of the Annual Meeting Virtual Experience.

“We think this is a study that can help orthopaedic physicians counsel patients on the different options available with regard to MUCL treatment in everyday laborers,” Dr. Marigi told AAOS Now.

The retrospective study assessed 25 cases of MUCL allograft reconstruction performed in nonelite (not collegiate or professional) athletes between 2000 and 2016 who had a minimum of two years of follow-up. Allografts were predominantly plantaris, although some hamstring grafts were utilized.

The average time to follow-up was 90.5 months (range, 25–195 months), and the average age at the time of surgery was 25.3 years (range, 12–65 years). There were no revision operations for recurrent instability. At most recent follow-up, the average Summary Outcome Determination score was 8.8 (range, 5–10), and the average Andrews-Timmerman score was 96.2 (range, 80–100). Patients also had a high rate of return to activity, according to Dr. Marigi. There was no difference in clinical outcomes based on type of allograft used (plantaris, semitendinosus, peroneus longus).

Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) or contracture (n = 1), and one patient underwent surgical intervention for combined ulnar neuropathy and contracture.

“These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency,” said Dr. Marigi.

He said future studies on the topic should include prospective or matched cohort series comparing autograft versus multiple allograft sources to better understand and characterize the unique differences that may occur during MUCL reconstruction in nonelite athletes.

The study is limited by its retrospective design and small sample size. “We were unable to analyze for other confounding variables and comorbidities that could influence our outcomes; thus, we suspect that the study may be underpowered to detect some differences in certain patient outcomes,” said Dr. Marigi.

Dr. Marigi’s coauthors of Poster 294, “Long-Term Outcomes of Allograft Reconstruction of the Medial Ulnar Collateral Ligament in Non-Elite Athletes,” are Justin C. Kennon, Chad Ellis Songy, Christopher Bernard, Joaquin Sanchez-Sotelo, Shawn W. O’Driscoll, and Christopher L. Camp.

Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at kefitzgerald@aaos.org.