Complications and Outcomes After Medial Ulnar Collateral Ligament Reconstruction: A Meta-Regression and Systematic Review

BACKGROUND: Evidence is limited regarding the complications and outcomes after medial ulnar collateral ligament (UCL) reconstruction. The published data regarding this procedure are composed predominantly of small Level-III and IV retrospective studies for which meta-analysis is not generally useful. Meta-regression is an alternative technique to identify variables across multiple publications that have an effect on published outcomes and complication rates. METHODS: We performed a systematic search of published literature for outcomes after UCL reconstruction. A random effects meta-regression model was constructed to identify the association of study characteristics with outcome proportions. Sensitivity analyses were performed to assess the impact of influential studies on the results. RESULTS: Fourteen studies (median sample size, 26 patients; range, 10 to 743 patients) were included in the systematic review and meta-regression. These studies included a total of 1,177 patients with a reported Conway outcome rating (a measure of a patient's return to play). The majority of patients (mean, 83.2%) achieved an excellent Conway rating. Studies involving the docking technique were more likely to have a higher percentage of patients with an excellent outcome (14% risk difference compared with the figure-of-8 technique, p = 0.002) and lower reported rates of ulnar neurapraxia (Spearman correlation = -0.83). A lower reported rate of ulnar neurapraxia was strongly associated with the likelihood of an excellent (p = 0.01) or good or excellent (p = 0.001) Conway outcome rating. CONCLUSIONS: Despite substantial heterogeneity among study outcomes, studies that involved a docking technique and that had lower reported rates of ulnar neurapraxia were associated with greater percentages of excellent or good-to-excellent reported Conway outcome ratings. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.