Are Suture Spanning Repair Techniques Replacing Traditional Tommy John Surgery? Prevalence and Complication Rates Following Ulnar Collateral Ligament Repair or Reconstruction.
Level 3 - non-randomized controlled study
Retrospective non-randomized comparative cohort study using national administrative claims data
PubMed 42422464 · doi:10.1177/23259671261454330
What was done
A retrospective cohort study was conducted using the Merative MarketScan national claims database to evaluate surgical trends and complications in patients aged 14 to 30 years who underwent ulnar collateral ligament (UCL) reconstruction (n = 1191) or repair (n = 696) between 2016 and 2021. Patients with concomitant fractures were excluded. Assessed outcomes included procedural volume trends over time, demographic factors, the use of concomitant ulnar nerve transposition (UNT), and short-term complications including infection, ulnar neuropathy, device-related, and unspecified complications.
What was found
From 2016 to 2021, UCL repairs increased by 81.6% while reconstructions decreased by 32.0%. Patients undergoing reconstruction were approximately 3 years older on average than those undergoing repair (P < .001). Male patients accounted for 89.5% of reconstructions and 77.7% of repairs. Concomitant UNT was performed in 36.8% of patients. There were no statistically significant differences in infection rates (P = .36) or ulnar neuropathy rates (P = .73) between groups. The overall complication rate was 1.58% for repair versus 0.67% for reconstruction (P = .09).
Why it matters
This study documents a substantial practice shift in the United States toward suture-spanning UCL repair over traditional reconstruction in younger athletes, while confirming that short-term complication rates remain low for both approaches.
Limits
As an administrative claims database study, it relies on coding accuracy and lacks clinical granularity, such as tear severity, tear location, or specific athletic activities. The abstract does not report long-term functional outcomes, reoperation rates, or return-to-sport metrics.