Similar return to sport between double cortical button and docking techniques for ulnar collateral ligament reconstruction in baseball players

Abstract

A double cortical button technique for ulnar collateral ligament reconstruction (UCLR) has advantages including significant control over graft tensioning, less concern about graft length and minimized risk of bone tunnel fracture compared to traditional UCLR techniques. This double cortical button technique was recently found to be non-inferior in mechanical performance compared to the traditional docking technique regarding joint strength, joint stiffness, and graft strain. However, clinical outcomes have not been compared between these UCLR techniques. Therefore, the purpose of this study was to determine whether baseball players who underwent UCLR with a double cortical button (double button) technique have similar return to sport (RTS) outcomes compared to baseball players who underwent UCLR with the traditional docking (docking) technique. Baseball players that underwent primary UCLR from 2011-2020 across two institutions were identified. Included patients were contacted to complete a follow-up survey evaluating reoperations, RTS, and functional outcome scores. Functional outcome surveys include the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway-Jobe score, Andrews-Timmerman (AT) elbow score, and the Single Assessment Numeric Evaluation (SANE) score. Overall, 78 male baseball players (age: 18.9±2.4 years) with an average follow-up of 3.1±2.4 years were evaluated, with 73 of the players being baseball pitchers. Players in the double button group more frequently received palmaris longus autografts (78% vs. 30%) and less frequently received gracilis autografts (22% vs. 58%) compared to players in the docking group (p=0.001); however, all other demographic factors were similar between groups. All players in the double button group were able to RTS in 11.1±2.6 months, while 96% of players in the docking group were able to RTS in 13.5±3.4 months (p>0.05). All post-operative outcomes and patient-reported outcomes were statistically similar between groups, and remained similar after isolating pitchers only and after separating partial-thickness from full-thickness UCL tears (all p>0.05). Return to sport and other post-operative outcomes may be similar between baseball players who underwent UCLR with the double button technique and the docking technique. While future research may be necessary to strengthen clinical recommendations, these findings provide the first clinical outcomes in light of a recent cadaveric study finding similar elbow strength, joint stiffness, and graft strain compared to the docking technique.