Double button vs. docking technique yield similar outcomes after UCL reconstruction
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Key takeaways:
- Double button vs. docking UCL reconstruction yielded similar return to sport rates and postoperative outcomes in baseball players.
- These findings align with previous biomechanical studies.
Patients who underwent ulnar collateral ligament reconstruction with a double cortical button technique vs. a traditional docking technique had similar return to sport rates and postoperative outcomes, according to published results.
John D. Kelly IV, MD, and colleagues analyzed data from 78 male baseball players (mean age of 18.9 years) who underwent primary UCL reconstruction from 2011 to 2020 with an average follow-up of 3.1 years. According to the study, 18 patients received the double button technique, and 60 patients received the docking technique. Of the cohort, 93.6% of players were pitchers.
Primary outcome measure was return to sport. Functional outcome measures, including Kerlan-Jobe Orthopaedic Clinic (KJOC) scores, Andrews-Timmerman elbow scores and single assessment numeric evaluation (SANE) scores, were completed by 55 players (71%).
Among the double button cohort, 78% of patients received a palmaris longus autograft, 22% received a gracilis autograft and no patients received a gracilis allograft. Among the docking cohort, 30% of patients received a palmaris longus autograft, 58% received a gracilis autograft and 13% received a gracilis allograft.
The double button cohort had a 100% return to sport rate at a mean 11.1 months, while the docking cohort had a 95.7% return to sport rate at a mean 13.5 months. Additionally, KJOC scores were 84.2 in the double button cohort and 76.7 in the docking cohort; Andrews-Timmerman elbow scores were 93.5 in the double button cohort and 87.6 in the docking cohort; and SANE scores were 87.2 in the double button cohort and 78.6 in the docking cohort.
Researchers concluded all postoperative outcomes were statistically similar between the cohorts even after comparing pitchers vs. position players and partial-thickness vs. full-thickness tears.
“G. Russell Huffman, MD, MPH, devised this double button technique several years ago, and it has previously proven to be biomechanically equivalent to the standard docking technique. Now we have clinical data to support its use,” Kelly told Healio. “The advantages of this technique include its less invasive nature as only single tunnels are required. In addition, there is less concern for tunnel or graft mismatching as the button technique affords the surgeon the ability to recess the graft into bone within a large range. This technique should incur less fracture risk since single tunnels are employed,” Kelly added.
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