Long-term Outcomes After Ulnar Collateral Ligament Reconstruction in Competitive Baseball Players

Osbahr, Daryl C.; Cain, E. Lyle; Raines, Benjamin Todd; Fortenbaugh, Dave; Dugas, Jeffrey R.; Andrews, James R.

doi:10.1177/0363546514528870

Cited by 113 publications

(45 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 8 , 15 , 28 , 30 , 35 , 44 Earlier studies that reported revision UCL rates of 1% to 2% included athletes with any overhead component, including sports such as wrestling, soccer, gymnastics, cheerleading, and pole vaulting; 8 this is in sharp contrast to the observed revision rate among baseball pitchers, which is much higher at 5% to 15%. 8 , 35 In a study of professional baseball pitchers, there was an increasing trend of revision UCL from 2010 to 2016 in both Major League Baseball (MLB) and Minor League Baseball (MiLB) players. 10 In this work, the overall mean revision UCL rate was 6.7%, with a rate of 9.4% in MLB and 5.2% in MiLB players ( P = .004).…”

Section: Discussionmentioning

confidence: 96%

Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

Kennon

Marigi

Songy

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

show abstract

Section: Discussionmentioning

confidence: 96%

Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

Kennon

Marigi

Songy

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…Surgical outcomes from the literature are listed in Table 2 (see Appendix 1). 6 , 7 , 16 , 18 , 33 , 44 , 49 , 51 , 57 Despite the public opinion that pitchers who undergo UCLR throw harder after surgery, evidence has shown that pitchers either maintain the same or lose a very small amount of velocity. 1 , 30 Unfortunately, no studies to date have shown a benefit to routine ulnar nerve transposition versus transposition in symptomatic patients.…”

Section: Surgical Outcomesmentioning

confidence: 99%

Ulnar Collateral Ligament Reconstruction

et al. 2015

View full text Add to dashboard Cite

Context:Ulnar collateral ligament (UCL) injuries lead to pain and loss of performance in the thrower’s elbow. Ulnar collateral ligament reconstruction (UCLR) is a reliable treatment option for the symptomatic, deficient UCL. Injury to the UCL usually occurs because of chronic accumulation of microtrauma, although acute ruptures occur and an acute-on-chronic presentation is also common.Evidence Acquisition:Computerized databases, references from pertinent articles, and research institutions were searched for all studies using the search terms ulnar collateral ligament from 1970 until 2015.Study Design:Clinical review.Level of Evidence:Level 5.Results:All studies reporting outcomes for UCLR are level 4. Most modern fixation methodologies appear to be biomechanically and clinically equivalent. Viable graft choices include ipsilateral palmaris longus tendon autograft, gracilis or semitendinosus autograft, and allograft. Clinical studies report excellent outcomes of UCLR for both recreational and elite level athletes with regard to return to sport and postoperative performance. Complications, although rare, include graft rerupture or attenuation, ulnar nerve symptoms, stiffness, pain, and/or weakness leading to decreased performance.Conclusion:Injuries to the UCL have become commonplace among pitchers. Nonoperative treatment should be attempted, but the limited studies have not shown promising results. Operative treatment can be performed with several techniques, with retrospective studies showing promising results. Complications include ulnar neuropathy as well as failure to return to sport. Detailed preoperative planning, meticulous surgical technique, and a comprehensive rehabilitation program are essential components to achieving a satisfactory result.

show abstract

“…At the professional level, high rates of return to play reaching 80% to 97% have been reported, with longer term data highlighting high postoperative satisfaction and return-to-play rates near 83% across multiple levels of competition. 1,5,9,11,15,21,22 However, despite favorable subjective satisfaction scores and rates of return to play, there are conflicting reports on postoperative statistical performance data in Major League Baseball (MLB) pitchers. 5,11,15 The effect of UCL injury on younger populations is an area of interest, given the increasing prevalence of UCLR.…”

mentioning

confidence: 99%

“…Although collegiate return-to-play rates have ranged from 88% to 92%, career longevity and postoperative player performance have not been specifically investigated in this population. 1,3,22,23 Therefore, the purpose of our study was to evaluate return to play and postinjury performance of collegiate baseball pitchers after UCLR. Our primary objective was to characterize return-to-play rates, career longevity, and collegiate eligibility status after surgery.…”

mentioning

confidence: 99%

Performance in Collegiate-Level Baseball Players After Elbow Ulnar Collateral Ligament Reconstruction

Swindell

Trofa

Confino

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: The increase in ulnar collateral ligament (UCL) elbow reconstructions over the past 20 years has affected younger athletes more than any other age group. Although return to play and postoperative performance have been extensively studied in professional baseball players, outcomes in collegiate baseball players are less known. Purpose/Hypothesis: The purpose of this study was to characterize return to play and changes in performance after UCL reconstruction (UCLR) in collegiate baseball players. We hypothesized that collegiate baseball players would have similar return-to-play rates compared with professional athletes and no significant differences in performance compared with matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Collegiate athletes undergoing UCLR by a single surgeon were identified. Postoperatively, individual collegiate career paths were analyzed through use of publicly available data from team websites, injury reports, and press releases. Data obtained included time to return to competition, number of collegiate seasons played after surgery, total games started and played, seasonal wins, losses, saves, innings played, hits, earned run average (ERA), home runs, shutouts, strikeouts, walks, and walks plus hit per inning pitched (WHIP). The UCLR group was compared with a matched control group of collegiate pitchers without elbow injury. Results: Of the 58 collegiate baseball players analyzed (mean ± SD age, 19.95 ± 1.19 years), 84.5% returned to play at the collegiate level. Players returned to competition at 16.98 ± 6.16 months postoperatively and competed for 1.60 ± 0.84 seasons postoperatively. In terms of career longevity, 81.0% of collegiate pitchers either completed their collegiate eligibility or remained on active rosters, and 2 players (4.1%) ultimately played at the professional level after UCLR. Compared with a matched cohort, the UCLR group had no significant differences in collegiate pitching performance statistics after surgery. Conclusion: College baseball players returned to play at a rate comparable with the rate published in prior literature on professional pitchers and often completed their collegiate playing eligibility postoperatively. Compared with controls, the UCLR group had no statistically significant differences in pitching performance postoperatively. Further studies are needed to determine the exact reasons why college players retire despite having endured extensive surgical and postoperative rehabilitation processes related to UCLR. Younger populations are experiencing elbow injuries at an increasing rate secondary to increased workloads at the amateur level. As these athletes matriculate into the collegiate ranks, they are at continued risk of sustaining UCL injury, and little explicit information is available on their prospects of return to play and career longevity after UCLR.

show abstract

Long-term Outcomes After Ulnar Collateral Ligament Reconstruction in Competitive Baseball Players

Cited by 113 publications

References 23 publications

Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

Ulnar Collateral Ligament Reconstruction

Performance in Collegiate-Level Baseball Players After Elbow Ulnar Collateral Ligament Reconstruction

Contact Info

Product

Resources

About