Medial Ulnar Collateral Ligament Reconstruction with Allograft Provides Excellent Clinical Outcomes, High Rates of Return to Play, and a Low Incidence of Postoperative Complications: A Systematic Review

PurposeTo perform a systematic review evaluating clinical outcomes in patients undergoing medial ulnar collateral ligament reconstruction (MUCLR) with soft tissue allograft.MethodsA systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcomes evaluated were patient-reported outcome scores, return to play (RTP) rates, incidence of postoperative complications, and rates of graft rupture or mechanical failure.ResultsThe literature search identified 395 articles and five studies met final inclusion criteria following full-text review. A total of 274 patients were analyzed in the included studies and follow up ranged from 3.0 to 7.6 years. Two studies (n patients = 141) reported outcomes exclusively of MUCLR with allograft, while three studies (n patients = 133) reported outcomes in patients undergoing MUCLR with either allograft or autograft. Allograft sources included gracilis, semitendinosus, plantaris, peroneus longus, and palmaris longus. Level of patient athletic competition ranged from recreational athletes to the professional level, however, non-athletes in the setting of trauma were also included. The RTP rate following MUCLR with soft tissue allograft was 95.3%, and 89.3% of patients returned to a similar or higher level of play postoperatively. The Timmerman-Andrews score was reported in two studies, and the means postoperatively ranged from 94.55 to 97. Postoperative complication rates were low (range, 0% to 20%) and there were no reported incidences of allograft rupture or mechanical failure.ConclusionBased on the available data, soft tissue allograft for MUCLR in athletic patient populations provides excellent clinical outcomes, high rates of RTP, and low rates of postoperative complications and graft failure at short-term follow-up. There remains a lack of high-quality evidence directly comparing autograft versus allograft outcomes in elite overhead throwing athletes to support allograft as an acceptable alternative for MUCLR in this patient population.