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Ulnar Nerve Complications Following Ulnar Collateral Ligament Reconstruction: A Systematic Review
Jason B Clain, BS1; Mark Vitale, MD, MPH, ONS, PC, ONS2; David Ruchelsman, MD3
1Tufts University School of Medicine, Boston, MA; 2Foundation for Clinical Research and Education, Greenwich, CT; 3Hand Surgery PC, Newton Wellesley Hospital, Newton, MA

Introduction: While ulnar collateral ligament reconstruction (UCLR) has been shown to be an effective procedure to restore elbow stability in overhead athletes, the rates of ulnar neuropathy following surgery has been poorly characterized. Furthermore, the influence of type of surgical exposure, graft fixation technique and concurrent ulnar nerve transposition on ulnar nerve complications is unclear. This study sought to determine the overall postoperative rate of ulnar neuropathy following UCLR and to determine how surgical exposure, graft fixation and intraoperative ulnar nerve management influenced the rate of ulnar nerve complications following UCLR.

Methods: Systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. UCLR case series that contained complications data were included. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit following surgery.

Results: Sixteen articles met inclusion criteria (n=1675 cases). The overall rate of post-operative ulnar neuropathy following UCLR was 10.7%, and 1.0% of cases required reoperation to address ulnar neuropathy. The surgical approach associated with the lowest rate of neuropathy was muscle splitting (4.7%) [versus muscle retraction (13.1%) and detachment of flexor pronator mass (18.2%)]. The fixation approach associated with the the lowest rate of neuropathy was the docking technique (2.4%) [versus hybrid suture anchor-bone tunnel (2.9%), interference screw (5.0%), DANE TJ (9.1%), figure of 8 (9.3%)]. Concurrent ulnar nerve transposition was associated with a higher neuropathy rate (13.0%) compared to no handling of the ulnar nerve (4.0%).

Discussion/Conclusion: Review of all published literature revealed that 1 in 10 UCLR results in postoperative ulnar nerve complications. UCLR techniques associated with the lowest rates of neuropathy were the muscle splitting approach, docking fixation, and lack of ulnar nerve transposition. This data may help guide surgeons on ways to minimize ulnar nerve complications following this procedure.

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