Similar outcomes after UCL reconstruction seen with modified Jobe vs docking techniques

Patrick C. McCulloch, MD

Elbow UCL injuries have become increasingly more common in both professional and youth baseball players in the past 10 years, and UCL reconstruction remains the current gold standard of treatment for these injuries in throwers who wish to return to play at a high level and who have failed nonoperative treatment.

This paper examined a single surgeon’s experience, James P. Bradley, MD, using two well-established techniques for performing UCL reconstruction: the modified Jobe technique and the docking technique. This study is the first direct clinical comparison of these two techniques by a single surgeon. Several studies have compared the results of these two techniques using systematic reviews, and more recently through the use of the Major League Baseball injury database. In general, these studies have shown both techniques to have similarly high success rates with respect to return to play. However, the results of those studies are also biased by the weight of studies by James Andrews, MD, as he is arguably the world’s expert at the modified Jobe technique.

The study by Bradley and colleagues showed there were no medial epicondyle fractures in either group and the rate of transient ulnar neuritis was lower than in other studies, which is useful information as these are concerns purported by proponents of the docking technique. However, there were twice as many athletes who underwent further surgery on the throwing arm, including three elbow arthroscopies compared to one after the Jobe technique vs. the docking, respectively. While this did not meet statistical significance in this size sample, it is likely underpowered to detect differences for relatively rare events. It is important to not over-read P-values as this is what is known as a fragile finding; meaning one fewer subsequent elbow procedure in the docking group would have resulted in statistical significance and an entirely different conclusion. The same case could be made for their finding of higher Kerlan-Jobe scores in their palmaris vs. hamstring graft data, as this was based on smaller numbers, surgeon preference and graft availability. Brandon J. Erickson, MD, and colleagues looked at a larger sample of professional pitcher data using the MLB HITS database and found no difference in return to sport or time to return between those with hamstring grafts vs. palmaris.

While proponents of a particular UCL reconstruction technique or graft choice may have strong opinions, this series from Bradley and colleagues comes to the same conclusion as the preponderance of other studies by suggesting that both techniques yield similar results for return to play, Kerlan-Jobe score or need for subsequent surgery. Both techniques are suitable options for UCL reconstruction and, in my opinion, the skill and experience of the surgeon far outweigh the differences in technique when it comes to getting throwers back to play.

Reference:

Erickson BJ, et al. Am J Sports Med. 2019;doi:10.1177/0363546519836086.