Editorial Commentary: Elbow Ulnar Collateral Ligament Repair With Suture Tape Augmentation Versus Reconstruction Should Be Determined Using Precise Imaging and Indications.

Abstract

Current surgical treatment options for ulnar collateral ligament (UCL) injury of the elbow include both reconstruction and repair. A growing amount of research has evaluated the outcomes of these various techniques in a variety of study designs. Large national database assessment indicates that overall failure rates are low and complication rates are similar between UCL reconstruction and UCL repair techniques. In addition, although the incidence of revision UCL surgery is low, UCL repair is associated with a significantly greater risk of revision than UCL reconstruction. This information is important in counseling our patients and urges us to perform higher-level, comparative research of these 2 surgical techniques in order to more precisely sculpt the optimal treatment algorithm for UCL injury. In my experience, preoperative advanced imaging including magnetic resonance imaging, magnetic resonance arthrography, and stress ultrasound are invaluable in determining the location and degree of UCL injury and, equally importantly, the status of the remaining ligament. These are key factors in deciding whether a particular patient is appropriate for UCL reconstruction or repair according to the indications defined by Dugas (with suture tape augmentation): "complete or partial avulsion of the UCL from either the sublime tubercle or medial epicondyle, without evidence of poor tissue quality of the ligament."