Revision Medial Ulnar Collateral Ligament Reconstruction in Baseball Pitchers: Review of Epidemiology, Surgical Techniques, and Outcomes

Abstract

Purpose of Review The purposes of this review are to describe the epidemiology, treatment options, and clinical outcomes of revision medial ulnar collateral ligament reconstruction in baseball pitchers. Recent Findings Rates of revision UCL range from 1 to 15% and have slowly increased over the past several years. Revision UCL procedures are associated with higher complication rates, likely due to the distortion of innate anatomy after primary reconstruction. Techniques for reconstruction are largely influenced by the index surgery and integrity of the ulnar and humeral bone tunnels/sockets. Current literature reporting on the outcomes following revision UCL reconstruction is limited to case series and database studies. Mean time between primary reconstruction and revision surgery is approximately 5 years and return to play rates range from 47 to 85%. Summary Outcomes following revision UCL reconstruction are relatively guarded compared with those of primary UCL reconstruction with the most studies reporting lower return to play rates, decreased workloads compared with pre-injury levels of play, and shorter career longevity following revision surgery. Future research regarding optimal reconstruction techniques and post-operative rehabilitation are needed as the incidence and demand for this procedure is expected to increase.

ChatGPT Can Offer Satisfactory Responses to Common Patient Questions Regarding Elbow Ulnar Collateral Ligament Reconstruction

“…The ChatGPT response regarding retear of the UCL after reconstruction is an accurate and concise statement. The current rate of retear after a UCL reconstruction is reported to range from 1% to 15% depending on the sport of the athlete undergoing the reconstruction, 36 , 58 , 59 , 60 which the ChatBot should report as this is imperative for athletes to understand preoperatively. Pitchers are at significantly greater risk for reinjury requiring revision UCL reconstruction (5%-15%) compared with nonpitching overhead athletes (i.e., baseball position players, javelin throwers; 1%-2%).…”

“…In patients requiring revision UCL reconstruction, the time to reinjury is variable, ranging from 1 to 13 years, with an average time to reinjury of 5 years. 60 , 61 , 62 Following reinjury after UCL reconstruction, patients requiring revision UCL reconstruction demonstrate substantially lower rates of return to sport at any level (46%-85%) and return to sport at their previous competitive level (33%-78%) compared with primary UCL reconstruction. 58 , 59 , 60 , 63 …”

“… 60 , 61 , 62 Following reinjury after UCL reconstruction, patients requiring revision UCL reconstruction demonstrate substantially lower rates of return to sport at any level (46%-85%) and return to sport at their previous competitive level (33%-78%) compared with primary UCL reconstruction. 58 , 59 , 60 , 63 …”