Thank you. I have no relevant disclosures. In 1974, Dr. Frank Jobe revolutionized the management of UCL injury with the very first UCL reconstruction. And over the last 50 years, this technique has been modified to limit its morbidity. More recently, Dave Olchek developed the docking technique to address some of the very same technical challenges. Numerous biomechanical studies have demonstrated similar performance. A number of systematic reviews exist. Some of those suggest higher return to play and lower complications with the docking technique, although no high-level direct comparison exists. And so the purpose of the current study was to perform the first prospective randomized single-blinded trial of the modified Jobe versus docking techniques for UCLR. And we hypothesized that there'd be no significant difference in terms of PROs, return to play, complications, baseball metrics, and post-operative advanced imaging. Skeletally mature overhead athletes with UCL injury were included. Non-overhead athletes and those with prior elbow surgery were excluded. Preoperative evaluation included thorough examination of the entire kinetic chain, as well as MR and stress ultrasound. Patients were randomized and remained blinded. All cases were performed by a single high-volume surgeon. Using a uniform approach, autographed, position of fixation, closure, and post-operative immobilization. We utilized the standard tunnel configurations. Elbow arthroscopy was performed if indicated. Ulnar nerve transposition was performed only for preoperative symptoms. All patients were treated with this uniform standardized rehabilitation. We collected clinical data, including demographics, anthropometrics, intraoperative variables and complications. PROs were collected at regular intervals, including KJOC, Andrews-Timmerman, Conway-Jobe, and a custom baseball questionnaire. Post-operative MR and stress ultrasound were obtained after at least one year post-op. A priori power analysis was performed using previously reported KJOC scores. Statistical analysis was performed based on variable type and normality. 80 patients were randomized and greater than 80% final follow-up was obtained. Preoperatively there were no differences in terms of patient characteristics, PROs, baseball metrics or advanced imaging findings. Intraoperatively the only difference was faster tourniquet time for the docking technique. In terms of KJOC scores there were no differences up to 18 months, but docking had higher scores at two years. In terms of Andrews-Timmerman there were no differences. In terms of Conway-Jobe return to sport and time to return to sport there were no differences. In terms of baseball specific metrics there were no differences. MR was obtained in 55 athletes at an average of 20 months post-op and there was no difference in graft status. Stress ultrasound was obtained in 49 athletes at an average of 19 months post-op. There was no difference in terms of joint gapping, but graft thickness was significantly greater for the Jobe technique. There was no difference in complications. A single patient underwent a revision ulnar nerve transposition. The current study is the first prospective randomized single-blinded trial comparing these two techniques and the single most important finding is that both achieved similar rates of good to excellent results. In fact for the majority of our measures there were no differences between the two techniques, although a small number of differences were identified. First docking technique was more time efficient with tourniquet time approximately 10 minutes faster. Graft thickness was greater for the Jobe technique. We attribute this to the graft configuration, but clinical significance is unclear. Docking did have higher final KJOC scores. This was an unanticipated finding. They were identical at all of their time points. It may be statistically fragile. The existing literature has a number of recognized deficiencies. A significant portion of the Jobe literature doesn't include modern modifications and likely depresses the results of the Jobe technique. The majority of the literature utilizes only a single measure to assess outcome and that limits the ways that we can compare different studies. Finally the majority of those comparisons are indirect. Only a single non-randomized retrospective direct comparison exists. The current study was designed to address each of these limitations with the most thorough collection of assessments including post-operative imaging, randomization and blinding to reduce bias. Modern standard of care surgical technique performed in a uniform manner by an experienced surgeon using a single graft with no difference in the number of nerve transpositions and an identical rehab. However, we acknowledge some limitations. The results remain relatively short term. Brasilis was consciously selected to reduce variability but at least one study suggests that palmaris may be superior. And finally COVID did impact our ability to obtain some post-operative imaging. Nonetheless, this remains the definitive evaluation of these surgical techniques. Surgeons should remain confident that both can achieve high rates of good to excellent results, equivalent return to play and time to return to play. I'd like to thank my co-authors and I'd like to thank AOSSM for the opportunity to report our results. We will have probably a few minutes for a question and answer session at the end but I do want to ask a couple of questions, Michael. First off, remarkable paper with great respect. I say this is a terrific step forward in our understanding of really the difference between these two studies. I would ask a couple of questions. 18 months, the KJOC score was essentially the same but at 24 months there was a significant drop in the KJOC score for the figure of eight method. Do you think that if you go forward another year that you'll see that that continues to drop or do you think it's going to level out? I know that you can't predict that but what was your, do you have any indication of why the KJOC score dropped over that time period? I can't speculate as to why the KJOCs dropped in the Modified JOB cohort at that time point. But in general, I do question to some degree two-year follow-up. I know it's the standard for a lot of our literature. But it may be slightly premature in this patient population. We know that return to sport for pitchers in particular after UCL reconstruction can be anywhere from 12 to 18 months. And to assess outcome very briefly after that, it may be somewhat premature. And so I do think it would be beneficial to follow patients out longer. I did note that as one of the limitations of the study and we do intend to follow the patients and revisit them in a couple of years to reassess the outcomes. Before we go to the next talk, are there any quick questions from the audience? Okay. Great. And I'll introduce the next speaker. And also, we do have the polls open online, so feel free to submit questions online. So our next speaker is...

UCL reconstruction surgery

modified Jobe technique

docking technique

patient-reported outcomes

return to play