Rehabilitation Variability After Elbow Ulnar Collateral Ligament Reconstruction

Abstract

Background:Investigations specifically delineating the safest and most efficacious components of physical therapy after ulnar collateral ligament (UCL) reconstruction of the elbow are lacking. As such, while a number of recommendations regarding postoperative therapy have been published, no validated rehabilitation guidelines currently exist.Purpose:To assess the variability of rehabilitation protocols utilized by orthopaedic residency programs in the United States (US) and those described in the scientific literature.Study Design:Cross-sectional study.Methods:Online UCL reconstruction rehabilitation protocols from US orthopaedic programs and from the scientific literature were reviewed. A comprehensive scoring rubric was developed to assess each protocol for the presence of various rehabilitation components as well as the timing of their introduction.Results:Overall, 22 protocols (14%) from 155 US Electronic Residency Application Service (ERAS) orthopaedic programs and 8 protocols published in the scientific literature detailing UCL reconstruction postoperative rehabilitation were identified and reviewed. After reconstruction, the majority of ERAS and review article protocols (77% and 88%, respectively) advised immediate splinting at 90° of elbow flexion. The mean time to splint discontinuation across all protocols was 2.0 weeks (range, 1-3 weeks). There was considerable variability in elbow range of motion recommendations; however, most protocols detailed goals for full extension and full flexion (>130°) at a mean 5.3 weeks (range, 4-6 weeks) and 5.5 weeks (range, 4-6 weeks), respectively. Significant diversity in the inclusion and timing of strengthening, proprioceptive, and throwing exercises was also apparent. Thirteen ERAS (59%) and 7 review article (88%) protocols specifically mentioned return to competition as an endpoint. ERAS protocols permitted return to competition significantly earlier than review article protocols (29.6 vs 39.0 weeks, respectively; P = .042).Conclusion:There is notable variability in both the composition and timing of rehabilitation components across a small number of protocols available online. While our understanding of postoperative rehabilitation for UCL reconstruction evolves, outcome-based studies focused on identifying clinically beneficial modalities and metrics are necessary to enable meaningful standardization.

Rehabilitation Variability Following Femoral Condyle and Patellofemoral Microfracture Surgery of the Knee

“…However, our methodology followed previous investigations and specifically included protocols from academic institution as the authors suspect the information provided by these centers would be most likely evidence-based modalities and treatment approaches. 23,27-29,31 Furthermore, many orthopedic surgeons design individualized protocols for patients, based on their preoperative condition and intraoperative decisions, which are then given directly to patients or physical therapists. As such, these individualized recommendations would not be captured by our review of the data currently online.…”

“…Using a methodology previously outlined by several studies on variability in rehabilitation protocols, 23,27-31 publicly available online rehabilitation protocols from academic orthopedic surgery programs in the United States were reviewed. Programs were identified from the Electronic Residency Application Service (ERAS).…”

“…Academically focused protocols were specifically selected to minimize potential bias and variability obtained through online search engines. A web-based query was performed (www.Google.com) using the search term “[Program/affiliate hospital/affiliate medical school name] microfracture rehabilitation protocol.” 27-29,31 Protocols designed for pediatric patients, those pertaining to concomitant procedures (ACL reconstruction, meniscal repair or debridement, osteochondral autograft and osteochondral allograft transfer system), protocols not associated with academic orthopedic surgery programs and those lacking details about specific elements of the rehabilitation, such as time points for the initiation and progression of protocol elements, were excluded from final review. Protocols that did not provide specifics on the type of articular cartilage restoration procedure performed were also excluded.…”

“…The quality and variability of postoperative rehabilitation protocols for anterior cruciate ligament (ACL) reconstruction, 23 medial patellofemoral ligament reconstruction, 27 meniscal repair, 28 proximal hamstring repair, 29 Achilles tendon repair, 30 and ulnar collateral ligament 31 reconstruction have been previously assessed with significant heterogeneity found between recommended rehabilitation protocols. Similarly, the present investigation sought to assess the variability of online postoperative patellofemoral and femoral condyle microfracture rehabilitation protocols published by academic orthopedic surgery programs in the United States.…”

Return-to-Sport Criteria After Upper Extremity Surgery in Athletes—A Scoping Review, Part 2: Ulnar Collateral Ligament of the Elbow Procedures

“…Although numerous papers have described various postoperative rehabilitation protocols and milestones for RTS after eUCLS, data related to their implementation in clinical practice are lacking. 23,31,32 Thus, we excluded articles failing to report data in this category, which resulted in a small number of studies being analyzed in the current review. Although our results highlight the lack of RTS criteria after eUCLS in athletes, we were unable to determine whether these criteria were not used in practice or whether they were simply underreported in surgical case series.…”