Ulnar collateral ligament reconstruction (UCLR) of the elbow with either the docking or the modified Jobe technique both offer patients excellent results, according to a new study.
The study, “Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes,” was published on June 29, 2020 in The American Journal of Sports Medicine.
The modified Jobe technique involves using a series of tunnels in the ulna and humerus to pass the graft in a figure-8 formation. With the docking technique, however, the graft is secured over a bone bridge and never requires a submuscular ulnar nerve transposition.
While previous systematic reviews have suggested that the docking technique was superior to the modified Jobe technique, those reviews included studies in which the flexor-pronator mass was detached and a submuscular ulnar nerve transposition was required.
This systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis identified 21 studies that included 1,842 UCL reconstructions, 320 using the docking technique and 1,466 using the modified Jobe or figure-of-8 technique.
Overall, without controlling for the effect of flexor-pronator detachment and submuscular ulnar nerve transposition, there were a larger percentage of excellent outcomes with the docking technique (86.58%; 95% of CI, 80.42%-91.85%) than with the figure-of-8 reconstruction (76.76%; 95% of CI, 69.65%-83.25%; p = .031).
When those effects were controlled for, however, there was no significant difference between the two techniques (p = .139). There was no significant difference between techniques in time to return to sports (p = .729), although there was no return to play data available for reconstructions with flexor-pronator detachment and submuscular ulnar nerve transposition.
The researchers wrote, “There was no significant difference in the proportion of excellent Conway Scale Outcomes or [return to play] time between the docking and modified Jobe techniques for UCL reconstruction where the [flexor-pronator] was preserved and routine submuscular ulnar nerve transposition was not performed.”
