Clinical Outcomes of Ulnar Collateral Ligament Surgery in Nonthrowing Athletes

Abstract

Background: Ulnar collateral ligament (UCL) surgery continues to demonstrate excellent clinical outcomes and a high return-to-play (RTP) rate with a low complication rate. Recent studies have demonstrated similar clinical outcomes for baseball players who have undergone either UCL reconstruction or UCL repair. In comparison, few studies have assessed the clinical outcomes of UCL surgery for nonthrowing athletes. Purpose/Hypothesis: The primary objective of this study is to provide clinical outcomes of UCL surgery performed in nonthrowing athletes at a single institution with a minimum 2-year follow-up. Our hypothesis was that these patients would have similar clinical outcomes, complication rates, and RTP rates when compared with throwing athletes. Level of Evidence: Case series; Level of evidence, 4. Methods: From our longitudinal elbow registry, 40 nonthrowing athletes were identified who underwent UCL surgery (repair or reconstruction) between 2011 and 2019. Participant characteristics were recorded: age, sex, laterality, arm dominance, sport, level of competition, and type of surgery (UCL repair or reconstruction). Outcomes included RTP rate and average time, American Shoulder and Elbow Surgeons (ASES) scores, and complications. Results: From the 40 patients eligible for inclusion in this study with a minimum 2-year follow-up, 37 (93%) were successfully contacted: 16 male (43%) and 21 female (57%). Mean ± standard deviation age at the time of surgery was 18.0 ± 3.7 years. From the 37 technical procedures, 28 (76%) were UCL repairs and 9 (24%) were UCL reconstructions. For these patients, 15 (41%) had partial tears, 20 (54%) had complete tears, 1 (3%) had a medial epicondyle avulsion, and 1 (3%) had an unspecified pathology. Sports included football (n = 11), gymnastics (11), cheerleading (7), wrestling (4), volleyball (2), basketball (1), and acrobatics (1). Quarterbacks were excluded from the football patients, as quarterbacks are throwing athletes. Level of competition included high school (n = 26), college (8), professional (2), and youth sports (1). The RTP rate was 93% (26/28) at a mean 7.4 months for UCL repair and 100% (9/9) at a mean 10.0 months for UCL reconstruction. Mean ASES scores were 94.4 and 98.7 for UCL repair and reconstruction, respectively. Complications were low, with 2 patients in the UCL repair group requiring ulnar nerve transposition for ulnar nerve paresthesia. Conclusion: In nonthrowing athletes, patients undergoing UCL repair and UCL reconstruction show favorable outcomes at minimum 2-year follow-up. RTP and clinical outcomes are consistent with previous studies in baseball players as well as a parallel ongoing study conducted on non–baseball throwing athletes.

Management of Pediatric and Adolescent Sublime Tubercle Injuries: Isolated and Complex Patterns Demonstrate Distinct Etiologies and Radiographic Outcomes

“…11 More recent data from Dugas and colleagues has argued that overhead-throwing and nonthrowing athletes may benefit from acute primary repair of the distal UCL, which should be of consideration when evaluating these patients. 13,14 Of note, none of our patients underwent primary distal UCL repair. When surgery was performed to address injury at the sublime tubercle, management consisted of UCL reconstruction.…”

“…The authors concluded that operative management was warranted in treating sublime tubercle avulsion injuries to return these patients to asymptomatic preinjury level of activity.11 Notably, initial nonsurgical management in this cohort consisted of immobilization in a range of motion brace locked at 90 degrees for 7 to 10 days, followed by 6 weeks of brace wear in an unlocked position 11 . More recent data from Dugas and colleagues has argued that overhead-throwing and nonthrowing athletes may benefit from acute primary repair of the distal UCL, which should be of consideration when evaluating these patients 13,14 . Of note, none of our patients underwent primary distal UCL repair.…”

Operative Versorgungsmöglichkeiten für mediale Instabilitäten am Ellenbogen

“…Die durchschnittliche Rückkehr zum Sport dauerte nur 6,7 Monate, was deutlich kürzer war als bei herkömmlichen Rekonstruktionsverfahren. Eine weitere Untersuchung von Rothermich et al zeigte bei nicht werfenden Athleten eine Rückkehr zum Sport von etwa 93 % nach durchschnittlich 7,4 Monaten 54 . Nach der Behandlung von mehr als 350 Athleten mit MUCL-Naht und interner Brace-Augmentation legten Wilk et al einen Rehabilitationsplan vor, der es den Athleten ermöglichte, nach etwa 5 Monaten wieder zu spielen 67 .…”

“…Nach der Behandlung von mehr als 350 Athleten mit MUCL-Naht und interner Brace-Augmentation legten Wilk et al einen Rehabilitationsplan vor, der es den Athleten ermöglichte, nach etwa 5 Monaten wieder zu spielen 67 . Rothermich et al berichten von exzellenten 2-Jahres-Ergebnissen auch bei Nichtwurfsportlern im American Shoulder and Elbow Surgeons (ASES) Score mit durchschnittlich 94,4 Punkten nach Internal Bracing des MUCL bei einer RTS-Rate von 93 % und einer RTS-Dauer von durchschnittlich 7,4 Monaten 54 . Die Komplikationsrate nach Internal Bracing des MUCL beträgt 11,9 % 53 .…”

“…Heutzutage ist eine steigende Inzidenz von MUCL-Verletzungen bei Amateur- und jugendlichen Sportlern zu beobachten, was zu einer raschen Zunahme der Anzahl von Rekonstruktionen in dieser Population geführt hat 7 , 27 , 52 . MUCL-Rupturen galten früher als „Karriereende-Verletzungen“ insbesondere für Leistungssportler, aber die Weiterentwicklung von chirurgischen Techniken zur MUCL-Refixation/Rekonstruktion ermöglicht die erfolgreiche Rückkehr auf ein hohes Wettkampfniveau 3 , 7 , 15 , 52 , 53 , 54 , 57 . Die MUCL-Refixation mit Bracing (zusätzliches Einziehen eines Kunstfaserbandes) ist dabei die neueste Variation und wird aufgrund ihrer vielversprechenden mittelfristigen klinischen Ergebnisse zunehmend anerkannt 15 , 54 , 67 .…”