Ulnar collateral ligament reconstruction (UCLR) of the elbow with either the docking or the modified Jobe technique both offer patients excellent results, according to a new study.
Either Docking or Modified Jobe Good for Elbow UCLR
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Secondary#dockingtechnique#modifiedjobetechnique#ulnarligamentreconstruction
The study, “Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes,” was published on June 29, 2020 in The American Journal of Sports Medicine.
The modified Jobe technique involves using a series of tunnels in the ulna and humerus to pass the graft in a figure-8 formation. With the docking technique, however, the graft is secured over a bone bridge and never requires a submuscular ulnar nerve transposition.
While previous systematic reviews have suggested that the docking technique was superior to the modified Jobe technique, those reviews included studies in which the flexor-pronator mass was detached and a submuscular ulnar nerve transposition was required.
This systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis identified 21 studies that included 1,842 UCL reconstructions, 320 using the docking technique and 1,466 using the modified Jobe or figure-of-8 technique.
Overall, without controlling for the effect of flexor-pronator detachment and submuscular ulnar nerve transposition, there were a larger percentage of excellent outcomes with the docking technique (86.58%; 95% of CI, 80.42%-91.85%) than with the figure-of-8 reconstruction (76.76%; 95% of CI, 69.65%-83.25%; p = .031).
When those effects were controlled for, however, there was no significant difference between the two techniques (p = .139). There was no significant difference between techniques in time to return to sports (p = .729), although there was no return to play data available for reconstructions with flexor-pronator detachment and submuscular ulnar nerve transposition.
The researchers wrote, “There was no significant difference in the proportion of excellent Conway Scale Outcomes or [return to play] time between the docking and modified Jobe techniques for UCL reconstruction where the [flexor-pronator] was preserved and routine submuscular ulnar nerve transposition was not performed.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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