According to a new systematic literature review, patients who receive palmaris grafts are slightly more likely to return to sport or return-to-same level than patients who had received hamstring tendon grafts.
In the study, “Return-to-Sport Outcomes After Primary Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Tendon Grafts: A Systematic Review,” published December 2, 2021 in the Orthopaedic Journal of Sports Medicine, the researchers investigated whether palmaris or hamstring autografts offered more superior outcomes.
“Ulnar collateral ligament (UCL) reconstruction is the current gold standard of treatment for overhead athletes with a symptomatic, deficient UCL of the elbow who have failed nonoperative treatment and wish to return to sport (RTS) at a high level. The palmaris longus and hamstring tendons are common graft choices, but no study has analyzed the existing literature to assess whether one graft is superior to the other,” they wrote.
To conduct the review, the researchers searched PubMed, Embase and the Cochrane Library databases. Return to sport and return-to-same-level rates, patient-reported outcomes and complications were all included in the analysis.
Six studies with 2,154 elbows were included in the review. All the studies directly compared palmaris and hamstring use in UCL reconstruction. Follow-up in the studies ranged from 24 to 80.4 months and the mean patient age across all the studies was 21.8 years.
The mean return-to-same-level rate was 79.0% and the mean return to sport was 84.1%. The mean return to spot and return-to-same-level rates for the palmaris graft group were 84.6% and 82%, respectively. For the hamstring graft group, the mean return to sport and return-to-same-level rates were 80.8% and 80.8%.
There were no significant differences in return-to-same-level between the two groups (OR, 1.06; 95% CI, 0.77-1.46). Across all the studies, failures rates ranged from 0% to 7.1% with a combined complication rate of 18.2%.
“Results of this review indicated that both palmaris and hamstring tendon grafts are viable options for primary UCL reconstruction. Graft choice should be determined by a combination of patient and surgeon preference,” the researchers wrote.
The study authors included David P. Trofa, M.D., Michael Constant, Connor R. Crutchfield, Nicholas J. Dantzker, M.D., Bryan M. Saltzman, M.D., Sean Lynch, M.D., and Christopher S. Ahmad, M.D. of Columbia University Irving Medical Center in New York.
