دورية أكاديمية
Biomechanical Characteristics of Ulnar Collateral Ligament Injuries Treated With and Without Augmentation: A Network Meta-analysis of Controlled Laboratory Studies.
| العنوان: | Biomechanical Characteristics of Ulnar Collateral Ligament Injuries Treated With and Without Augmentation: A Network Meta-analysis of Controlled Laboratory Studies. |
|---|---|
| المؤلفون: | Kunze KN; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.; Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, New York, USA., Fury MS; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.; Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, New York, USA., Pareek A; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.; Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, New York, USA., Camp CL; Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA., Altchek DW; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.; Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, New York, USA., Dines JS; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.; Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, New York, USA. |
| المصدر: | The American journal of sports medicine [Am J Sports Med] 2024 May; Vol. 52 (6), pp. 1624-1634. Date of Electronic Publication: 2024 Feb 02. |
| نوع المنشور: | Journal Article; Meta-Analysis; Systematic Review |
| اللغة: | English |
| بيانات الدورية: | Publisher: Sage Publications Country of Publication: United States NLM ID: 7609541 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-3365 (Electronic) Linking ISSN: 03635465 NLM ISO Abbreviation: Am J Sports Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2004- : Thousand Oaks, CA : Sage Publications Original Publication: Baltimore, Williams & Wilkins. |
| مواضيع طبية MeSH: | Collateral Ligament, Ulnar*/injuries , Collateral Ligament, Ulnar*/surgery, Humans ; Biomechanical Phenomena ; Network Meta-Analysis ; Ulnar Collateral Ligament Reconstruction ; Suture Techniques ; Elbow Injuries |
| مستخلص: | Background: Treatment of ulnar collateral ligament (UCL) tears with suture tape augmentation has gained interest given preliminary reports of favorable biomechanical characteristics. No study to date has quantitatively assessed the biomechanical effects of multiple augmentation techniques relative to the native UCL. Purpose: To perform a systematic review and meta-analysis of controlled laboratory studies to assess and comparatively rank biomechanical effects of UCL repair or reconstruction with or without augmentation. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, OVID/Medline, and Cochrane databases were queried in January 2023. A frequentist network meta-analytic approach was used to perform mixed-treatment comparisons of UCL repair and reconstruction techniques with and without augmentation, with the native UCL as the reference condition. Pooled treatment estimates were quantified under the random-effects assumption. Competing treatments were ranked in the network meta-analysis by using point estimates and standard errors to calculate P scores (greater P score indicates superiority of treatment for given outcome). Results: Ten studies involving 206 elbow specimens in which a distal UCL tear was simulated were included. UCL reconstruction with suture tape augmentation (AugRecon) restored load to failure to a statistically noninferior magnitude (mean difference [MD], -1.99 N·m; 95% CI, -10.2 to 6.2 N·m; P = .63) compared with the native UCL. UCL reconstruction (Recon) (MD, -12.7 N·m; P < .001) and UCL repair with suture tape augmentation (AugRepair) (MD, -14.8 N·m; P < .001) were both statistically inferior to the native UCL. The AugRecon condition conferred greater load to failure compared with Recon ( P < .001) and AugRepair ( P = .002) conditions. AugRecon conferred greater torsional stiffness relative to all other conditions and was not statistically different from the native UCL (MD, 0.32 N·m/deg; 95% CI, -0.30 to 0.95 N·m/deg; P = .31). Medial ulnohumeral gapping was not statistically different for the AugRepair (MD, 0.30 mm; 95% CI, -1.22 to 1.82 mm; P = .70), AugRecon (MD, 0.57 mm; 95% CI, -0.70 to 1.84 mm; P = .38), or Recon (MD, 1.02 mm; 95% CI, -0.02 to 2.05 mm; P = .055) conditions compared with the native UCL. P-score analysis indicated that AugRecon was the most effective treatment for increasing ultimate load to failure and torsional stiffness, whereas AugRepair was the most effective for minimizing medial gapping. Conclusion: AugRecon restored load to failure and torsional stiffness most similar to the parameters of the native UCL, whereas Recon and AugRepair did not restore the same advantageous properties at time zero. Medial ulnohumeral gapping during a valgus load was minimized by all 3 treatments. Based on network interactions, AugRecon was the superior treatment approach for restoring important biomechanical features of the UCL at time zero that are jeopardized during a complete distal tear. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.S.F. has received support for education from Kairos Surgical. A.P. has received hospitality payments from Medical Device Business Services. C.L.C. has received consulting fees and IP royalties from Arthrex and research support from Major League Baseball. D.W.A. has received consulting fees from Stryker and royalties from Stryker and Arthrex. J.S.D. has received IP royalties from Arthrex and Linvatec, consulting fees from Arthrex and Trice Medical, and support for education from Gotham Surgical; he holds stock or stock options in ViewFi. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. |
| فهرسة مساهمة: | Keywords: Tommy John; UCL; augmentation; baseball injuries; biomechanics; cadaveric; elbow; reconstruction; repair; throwers; ulnar collateral ligament |
| تواريخ الأحداث: | Date Created: 20240202 Date Completed: 20240501 Latest Revision: 20240531 |
| رمز التحديث: | 20240601 |
| DOI: | 10.1177/03635465231188691 |
| PMID: | 38304942 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1552-3365 |
|---|---|
| DOI: | 10.1177/03635465231188691 |