Disproportionate trends in ulnar collateral ligament reconstruction: projections through 2025 and a literature review

Mahure, Siddharth A.; Mollon, Brent; Shamah, Steven; Kwon, Young W.; Rokito, Andrew S.

doi:10.1016/j.jse.2016.02.036

Cited by 110 publications

(101 citation statements)

References 36 publications

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“…17 Most concerning is the increasing frequency of ulnar collateral ligament (UCL) surgical reconstructions in baseball players during the past 20 years. 18,19 One report 18 suggested the number of UCL reconstructions between 2003 and 2014 increased 343%, with 56.6% in those aged 15 to 19 years. Furthermore, whereas the overall rate of UCL reconstructions has increased an average of 18.5% annually, the rate among adolescents increased more quickly than that among individuals older than 18.…”

Section: Epidemiologymentioning

confidence: 99%

“…Furthermore, whereas the overall rate of UCL reconstructions has increased an average of 18.5% annually, the rate among adolescents increased more quickly than that among individuals older than 18. 18 Given the volume of participation by adolescents in throwing sports and the rising injury rates, 20 we will review the associated risk factors for injury and the current injuryprevention recommendations from national and international governing bodies. We will also provide an overview of injury-prevention and intervention practices and suggest areas of future research.…”

Section: Epidemiologymentioning

confidence: 99%

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Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review

Zaremski

Zeppieri

Tripp

2019

Journal of Athletic Training

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A significant number of adolescent athletes throughout the world participate in various throwing-dominant sports, including but not limited to baseball, cricket, handball, softball, track and field throwing events, and water polo. Due to the unique stresses placed on the throwing arm and entire body in these sports, a robust volume of literature has highlighted concerns about sport specialization in these athletes and an associated increased risk of injury, particularly to the dominant shoulder and elbow, with sport specialization. This review will highlight the evidence-based literature for this athletic niche, focusing on risk factors for injury, national and international organizations' recommendations for limiting overuse injuries, principles of conditioning and rehabilitative programs, and potential future areas of research to curb the growing incidence of throwing-related injuries among adolescent throwing athletes.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review

Zaremski

Zeppieri

Tripp

2019

Journal of Athletic Training

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“…The overall number of UCL reconstructions performed between 2003 and 2014 has increased by 343% 6. In 2014 alone, more pitchers had undergone UCL reconstruction than in the entirety of the 1990s, and the rate of adolescent players undergoing surgery has been rising from none in the early 1990s to more than 40% in recent years (figure 4).…”

Section: Considerationmentioning

confidence: 99%

“…In 2014 alone, more pitchers had undergone UCL reconstruction than in the entirety of the 1990s, and the rate of adolescent players undergoing surgery has been rising from none in the early 1990s to more than 40% in recent years (figure 4). 6 The incidence of elbow pain in baseball players ranges from 20%–30% in players aged 8–12 years old, to 45% in those aged 13–14 years old, and over 50% in high school, collegiate and professional athletes 57. Currently, 57% of Tommy John surgeries are performed on athletes aged 15–19 years old 4…”

Section: Considerationmentioning

confidence: 99%

“…In this population, 39%–53% of elbow ligament injuries require surgery, predominantly in pitchers and primarily involving the UCL 18. Epidemiological studies have shown that the number of UCL reconstructions has been rising steadily 6. Disturbingly, there is a marked increase in the number of UCL reconstructions performed in amateur and adolescent athletes in the last decade 3 6 7 19…”

Section: Introductionmentioning

confidence: 99%

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Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes

et al. 2018

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This classic examines the landmark publication ‘Reconstruction of the Ulnar Collateral Ligament in Athletes’ by Jobe et al, published in 1986. Dr Frank W Jobe was the first to perform and describe a standard technique for ulnar collateral ligament (UCL) reconstruction with the use of a figure-of-eight configuration and submuscular ulnar nerve transposition to treat throwing athletes with UCL insufficiency. Before Jobe’s pioneering work, the initial operative approach to patients with UCL tears involved repair of the native ligament. Despite this treatment, injuries of the UCL were considered career-ending in those days. The original article describes the surgical technique for UCL reconstruction and the postoperative rehabilitation and outcomes in 16 throwing athletes, including Major League Baseball pitcher Tommy John (Los Angeles Dodgers). Jobe reported good results, with 10 of the 16 patients returning to their previous level of participation in sports, one patient returning to a lower level of participation and five patients retiring from professional athletics due to reasons not related to the operation. However, a high incidence of ulnar nerve complications was reported, requiring secondary surgery in two patients. In the decades following the original publication by Jobe et al, modifications of the Jobe technique, involving different graft choices, tunnel positions, and graft configurations and fixation methods have resulted in improved clinical results. Originally presented as a treatment option for elite athletes only, UCL reconstruction has gained public interest as incidence rates of ‘Tommy John surgery’ have reached epidemic proportions, especially in high school-aged baseball pitchers in the USA.

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Mechanical properties and microstructural organization of common ulnar collateral ligament grafts: Palmaris longus and gracilis tendons

Solon

Castile

Smith

et al. 2021

Journal Orthopaedic Research

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Ulnar collateral ligament (UCL) injuries are becoming increasingly common. The palmaris longus (PL) and gracilis (GR) tendons are the most common grafts used in UCL reconstructions. While clinical studies have demonstrated relatively similar outcomes for either graft, there is little quantitative data describing these grafts from a material perspective, specifically the mechanical and microstructural properties of these tissues and how they respond under dynamic loading. The purpose of this descriptive laboratory study was to quantify and compare the mechanical and microstructural properties of PL and GR tendons. A total of 13 PL and 11 GR cadaveric human tendons were obtained. Each specimen was divided into three subregions and subjected to preconditioning, ramp‐and‐hold stress‐relaxation and ramp‐to‐failure testing. Mechanical parameters were computed for each sample, and a polarized light imaging technique was used to simultaneously evaluate dynamic microstructural properties during testing. The PL had larger toe‐ and linear‐region modulus values than the GR. Within the GR, the distal subregion had stronger collagen alignment than the proximal subregion at the zero, transition and linear portions of the stress‐strain curve. The PL and GR, have similar mechanical properties and similar microstructural alignment under load. The PL graft has similar properties throughout its length whereas the GR properties exhibited slight differences in strength of alignment along its length. The PL and GR exhibit larger moduli values and more strongly/uniformly aligned collagenous microstructure when qualitatively compared to data previously published on the native UCL.

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Disproportionate trends in ulnar collateral ligament reconstruction: projections through 2025 and a literature review

Cited by 110 publications

References 36 publications

Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review

Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review

Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes

Mechanical properties and microstructural organization of common ulnar collateral ligament grafts: Palmaris longus and gracilis tendons

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