Long-Term Sports Participation and Satisfaction After UCL Reconstruction in Amateur Baseball Players

Abstract

Background: While the incidence of ulnar collateral ligament reconstruction (UCLR) has increased across all levels of play, few studies have investigated the long-term outcomes in nonprofessional athletes. Purpose: To determine the rate of progression to higher levels of play, long-term patient-reported outcomes (PROs), and long-term patient satisfaction in nonprofessional baseball players after UCLR. Study Design: Case series; Level of evidence, 4. Methods: We evaluated UCLR patients who were nonprofessional baseball athletes aged <25 years at a minimum of 5 years postoperatively. Patients were assessed with the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), the Timmerman-Andrews (T-A) Elbow score, the Mayo Elbow Performance Score (MEPS), and a custom return-to-play questionnaire. Results: A total of 91 baseball players met the inclusion criteria, and 67 (74%) patients were available to complete the follow-up surveys at a mean follow-up of 8.9 years (range, 5.5-13.9 years). At the time of the surgery, the mean age was 18.9 ± 1.9 years (range, 15-24 years). Return to play at any level was achieved in 57 (85%) players at a mean time of 12.6 months. Twenty-two (32.8%) of the initial cohort returned to play at the professional level. Also, 43 (79.1%) patients who initially returned to play after surgery reported not playing baseball at the final follow-up; of those patients, 12 reported their elbow as the main reason for eventual retirement. The overall KJOC, MEPS, and T-A scores were 82.8 ± 18.5 (range, 36-100), 96.7 ± 6.7 (range, 75-100), and 91.9 ± 11.4 (range, 50-100), respectively . There was an overall satisfaction score of 90.6 ± 21.5 out of 100, and 64 (95.5%) patients reported that they would undergo UCLR again. Conclusion: In nonprofessional baseball players after UCLR, there was a high rate of progression to higher levels of play. Long-term PRO scores and patient satisfaction were high. The large majority of patients who underwent UCLR would undergo surgery again at long-term follow-up, regardless of career advancement.

Return to Sport After Nonoperative Management of Elbow Ulnar Collateral Ligament Injuries: A Systematic Review and Meta-analysis

“…Studies often begin treatment of partial tears with a trial of nonoperative management, whereas complete tears proceed directly to surgery. 18,36 Further comparative studies evaluating performance and long-term outcomes related to career longevity in athletes treated nonoperatively versus operatively based on UCL injury severity are required to better understand the long-term outcomes in athletes sustaining UCL injuries. In addition, the indications for attempted nonoperative care are critical, particularly given the nature of the included studies that are case series.…”

“…The mean MINORS score was 11 6 4.17 (range, 6-21) (Figure 4). For noncomparative studies (n = 12), the mean score was 9.25 6 2.05 (range, [6][7][8][9][10][11][12], whereas the mean score for comparative studies (n = 3) was 18 6 2.65 (range, [16][17][18][19][20][21]. Based on the classification system Ekhtiari et al, 13 the noncomparative studies were of low quality and the comparative studies were of good quality.…”

“…However, a 2017 survey of members of the American Shoulder and Elbow Surgeons society reported a consensus among providers recommending UCL reconstruction for professional athletes with full-thickness UCL tears. 18 No consensus was reached among survey respondents regarding the optimal approach for partial tears or injuries in amateur athletes. 17 In athletes undergoing nonoperative management, treatment failure requiring subsequent operative treatment may result in prolonged time lost from sports.…”