Combined Flexor-Pronator Mass and Ulnar Collateral Ligament Injuries in the Elbows of Older Baseball Players

Abstract

A total of 187 male baseball players between 14 and 42 years of age (mean, 20.7 years) had an ulnar collateral ligament reconstruction by 1 surgeon. Eight (4%) of 187 baseball players were treated for the combined flexor-pronator/ulnar collateral ligament injury. There was a statistically significant difference in age between the ulnar collateral ligament group (20.1 years) and the flexor-pronator/ulnar collateral ligament group (33.4 years) (P < .001). Age > or =30 years was a statistically significant age limit to predict the presence of a combined flexor-pronator/ulnar collateral ligament injury (88%) compared with an isolated ulnar collateral ligament injury (1%) (P < .001). Outcomes were 1 excellent (12.5%), 2 fair (25%), and 5 poor (62.5%). Conclusion Combined fflexor-pronator and ulnar collateral ligament injuries in baseball players may portend a worse prognosis, with a 12.5% return to prior level of play. Older age (> or =30 years) is a risk factor in the development of this combined injury. When combined flexor-pronator/ulnar collateral ligament injury is suspected preoperatively, patients should be counseled on expected outcomes appropriately.

Prevalence of Ulnar Collateral Ligament Surgery in Professional Baseball Players

“…4,12 Throwing is particularly stressful on the UCL, placing large amounts of valgus torque across the medial elbow. 3,8,10,11,18 This opening stress of the medial elbow peaks near the instant of maximum shoulder external rotation and the arm's acceleration phase of throwing. 3,8,10,11,18 This stress appears to be the greatest in professional baseball pitchers.…”

“…3,8,10,11,18 This opening stress of the medial elbow peaks near the instant of maximum shoulder external rotation and the arm's acceleration phase of throwing. 3,8,10,11,18 This stress appears to be the greatest in professional baseball pitchers. 11,13 Numerous studies have documented successful outcomes in both the short term and the long term after UCL reconstruction in baseball players and other athletes, with return-to-play rates approaching as high as 90%.…”

Medial Collateral Ligament Tears in the Overhead Athlete: Surgical Indications and Reconstruction Technique

“…41 Flexor-pronator tear in combination with MCL reconstruction significantly compromises success with 12.5% return to prior level of play. 42 The presence of ulnohumeral chondromalacia noted at the time of MCL reconstruction has yielded inferior outcomes compared to historical results. 43 The presence of either significant calcification in the ligament or bone deficiency is also associated with inferior results.…”

Treatment of Medial Collateral Ligament Injuries of the Elbow with Use of the “Tommy John” Operation: Indications and Results

“…Flexorpronator tear in combination with MCL reconstruction significantly compromises success 42 . Osbahr et al described a prevalence of 4% combined flexorpronator and MCL tears in a series of 187 baseball players.…”