Background
Reconstruction or repair of the ulnar collateral ligament (UCL) may be routinely performed with or without ulnar nerve decompression. Although the procedure has become increasingly more common since it was popularized at the end of the 20th century, recent operative trends are less clear. The purpose of this study was to examine nationwide trends of UCL repair and reconstruction, with or without concomitant ulnar nerve procedures over the last decade and report on associated reimbursement of surgery.
Methods
We used national data to retrospectively analyze all patients (ages 10-40) who underwent UCL reconstruction or UCL repair from 2010-2019. The rate of concomitant ulnar nerve decompression (in situ release or transposition) was also assessed. Incidence and compound annual growth rates (CAGR) were used to determine surgical utilization. Index surgery and 90-day reimbursement figures were reported.
Results
Of the 39,930 UCL injuries recorded from 2010-2019, 3,146 patients underwent UCL surgery (1.04 incidence/100,000) with the majority being in the 15-19 age group. UCL reconstruction was more common than repair (2,195 vs. 951). While there was an increase in UCL injuries over the period studied (2.16%, P<0.001), there was no significant change in incidence for either surgical intervention. Concomitant ulnar nerve surgery increased over three-fold for UCL repair from 9.45% to 30.47% (CAGR= +12.42%; p=0.005) but remained unchanged for UCL reconstruction (CAGR= +2.39%; p=0.433). Reimbursement for both repair (CAGR= +15.37%; p<0.001) and reconstruction (CAGR= +9.35%; p=0.011) increased over this period with similar 90-day reimbursements by 2019 ($3,483 vs $3,874, respectively).
Conclusion
This study shows that while the incidence of UCL injury is increasing, the overall age adjusted CAGR has not significantly changed from 2010 to 2019. UCL repair is most frequently performed in younger patients (age 15-19) and has been more routinely performed with ulnar nerve decompression. While reimbursement has steadily increased for both types of surgeries, reimbursement for repair has now outpaced reconstruction.