Optimal management of ulnar collateral ligament injury in baseball pitchers

Background: Ulnar collateral ligament (UCL) reconstruction of the elbow is commonly performed on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought. Purpose: To provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Study Design: Case series; Level of evidence, 4. Methods: The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS, and surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play [RTP] rates, RTP times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (docking vs modified Jobe) and graft sources (palmaris longus autograft vs hamstring autograft). Results: A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1424 days (47 months) after their primary surgery. A trend was seen toward increasing numbers of revision surgeries over time ( R2 = 0.441; P = .104). The most commonly used tunnel configuration was the modified Jobe technique (n = 41; 59.4%), and the most commonly used graft was hamstring autograft (n = 34; 49.3%). A majority (76.6%) of pitchers achieved RTP, and 55.3% were able to return to the same level of play. Mean time to RTP was 436 days (14.5 months) for players with a palmaris longus autograft versus 540 days (18 months) for those with a hamstring autograft ( P = .108). Further, the mean time to RTP was 423 days (14 months) for the docking technique versus 519 days (17 months) for the modified Jobe technique ( P = .296). Similar rates of subsequent injuries and surgeries were noted between the 2 revision techniques and 2 most commonly used graft constructs. Conclusion: Revision UCL reconstruction showed relatively high RTP rates (77%), but only 55% of players returned to their same level of play. Mean time to RTP was shorter than that found in other, smaller investigations. Although general trends were seen toward decreased time to RTP for the docking technique and palmaris longus autograft, these differences did not reach statistical significance.

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“…In the absence of any clear superiority, surgical technique selection ultimately depends on the surgeon’s expertise and preference. 14…”

Section: Discussionmentioning

confidence: 99%

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Camp

Desai

Conte³

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Es wurden die Effekte auf die Schulterbeweglichkeit und -leistungsfähigkeit beurteilt, wobei sich beide Parameter in IG und KG ohne signifikante Gruppenunterschiede verbessert haben. Die Aussagekraft der Ergebnisse für Patienten ist kritisch zu hinterfragen, da solche Studien kein Symptomverhalten betrachten und physiologische Bedingungen nur bis zum Erreichen der physiologischen Grenze positiv beeinflusst werden können [34]. Die Effekte des Medical Flossings auf das Schmerzniveau wurden hingegen in einer Einzelfallstudie untersucht [12].…”

Section: Diskussionunclassified

Effekte von Medical Flossing bei Patienten mit Schulterbeschwerden – Randomisierte kontrollierte Pilotstudie

2020

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Zusammenfassung Hintergrund Schultererkrankungen mit Schmerzen und/oder Bewegungseinschränkungen sind die dritthäufigste physiotherapeutische Diagnosegruppe in Deutschland. Mittels Medical Flossing sollen durch Bewegung unter starker Kompression von Gewebe u. a. diese Symptome verbessert werden. Ziel Machbarkeit und Prüfung einer Evaluation der Anwendung von Medical Flossing im Praxisalltag hinsichtlich der Belastung und Sicherheit von Patienten sowie der standardisierten Umsetzbarkeit. Generierung von Daten für zukünftige Fallzahlkalkulationen. Dafür werden Effekte und Nebenwirkungen von Medical Flossing bei Patienten mit Schmerzen und/oder Bewegungseinschränkungen im Bereich des Schultergelenks evaluiert. Methode Die Teilnehmer der Studie erhielten fünf physiotherapeutische Behandlungen, die um eine Behandlung mit Medical Flossing oder mit Sham-Flossing ergänzt wurden. Primäres Outcome war die Funktion der oberen Extremität anhand des Disabilities of the Arm, Shoulder and Hand (DASH), sekundäre Outcomes waren u. a. das Schmerzniveau anhand der Numeric Rating Scale (NRS), das Bewegungsausmaß (ROM) und das Auftreten von Nebenwirkungen. Die Gründe für die Ablehnung einer Studienteilnahme wurden formlos erfasst. Ergebnisse Insgesamt wurden zwölf Teilnehmer in die Studie eingeschlossen. Weitere Personen haben die Teilnahme aufgrund von Vorbehalten gegenüber der Behandlungsmethode und des zusätzlichen Zeitaufwands durch die Datenerhebung abgelehnt. Funktion und Symptome wurden durch beide Behandlungsformen im Prä-Post-Vergleich positiv beeinflusst (DASH, max. NRS, ROM), statistisch signifikante Gruppenunterschiede existierten nicht. Bei allen Teilnehmern traten Nebenwirkungen auf, besonders Schmerzen und Hautveränderungen. Ernsthafte Symptome wie Kurzatmigkeit wurden vereinzelt in der Interventionsgruppe (IG) angegeben. Schlussfolgerung Funktion und Symptome wurden durch beide Behandlungsformen positiv beeinflusst, mit einer in Teilbereichen höheren klinischen Wirksamkeit des Sham-Flossings (DASH, max. NRS). Weiterführend sollten der spezifische Effekt des Medical Flossings und das Verhältnis von Wirkung und Nebenwirkung unter Einbezug der Zugstärke der Flossinganlage kritisch untersucht werden. Zudem könnte die Anzahl der Erhebungsinstrumente (funktionelle Armbewegungen, Goniometermessung) reduziert werden, um die Rekrutierung von Patienten zu erleichtern.

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“…In general, conservative treatment should be exerted before considering surgical intervention in incomplete UCL tears. Conservative treatment typically consists of early management of pain and inflammation and gradual increase of elbow range of motion, followed by a progressive strengthening programme including the elbow, trunk and shoulder musculature 91. The final phase of rehabilitation emphasises dynamic strengthening of the upper extremity and includes an interval throwing programme 92…”

Section: Considerationmentioning

confidence: 99%

Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes

et al. 2018

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This classic examines the landmark publication ‘Reconstruction of the Ulnar Collateral Ligament in Athletes’ by Jobe et al, published in 1986. Dr Frank W Jobe was the first to perform and describe a standard technique for ulnar collateral ligament (UCL) reconstruction with the use of a figure-of-eight configuration and submuscular ulnar nerve transposition to treat throwing athletes with UCL insufficiency. Before Jobe’s pioneering work, the initial operative approach to patients with UCL tears involved repair of the native ligament. Despite this treatment, injuries of the UCL were considered career-ending in those days. The original article describes the surgical technique for UCL reconstruction and the postoperative rehabilitation and outcomes in 16 throwing athletes, including Major League Baseball pitcher Tommy John (Los Angeles Dodgers). Jobe reported good results, with 10 of the 16 patients returning to their previous level of participation in sports, one patient returning to a lower level of participation and five patients retiring from professional athletics due to reasons not related to the operation. However, a high incidence of ulnar nerve complications was reported, requiring secondary surgery in two patients. In the decades following the original publication by Jobe et al, modifications of the Jobe technique, involving different graft choices, tunnel positions, and graft configurations and fixation methods have resulted in improved clinical results. Originally presented as a treatment option for elite athletes only, UCL reconstruction has gained public interest as incidence rates of ‘Tommy John surgery’ have reached epidemic proportions, especially in high school-aged baseball pitchers in the USA.

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Optimal management of ulnar collateral ligament injury in baseball pitchers

Cited by 23 publications

References 90 publications

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Effekte von Medical Flossing bei Patienten mit Schulterbeschwerden – Randomisierte kontrollierte Pilotstudie

Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes

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