Outcomes After Ulnar Collateral Ligament Revision Reconstruction in Baseball Players

Abstract

Background: There is a lack of evidence regarding the success of ulnar collateral ligament (UCL) revision reconstruction. Understanding outcomes after UCL revision reconstruction is important in clinical decision making for overhead athletes. Purpose: To evaluate return to play and patient-reported outcomes after UCL revision reconstruction. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent UCL revision reconstruction, attributed to retear of the ligament or pain, between June 2004 and July 2016 at 2 surgical centers were identified. Charts were reviewed for age, sex, date of primary and revision reconstruction, sport played, level of play, graft type, and complications. Patients were contacted by telephone to determine time to return to play, current level of participation, Conway score, Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, and satisfaction. Results: Of the 65 consecutive baseball players who underwent revision UCL reconstruction, 40 (62%) were contacted at a minimum 22 months after surgery. Of these, 38 (95%) were pitchers and 2 (5%) were position players. Time to return to throwing was 6.2 ± 2.3 months (mean ± SD), and the KJOC score was 74.2 ± 20.7. Based on the Conway score, 50% (20/40) had an excellent result, indicating a return to the previous competition level for at least 1 year, and 30% (12/40) had a good result, indicating a return to a lower level for at least 1 year. For those who were able to return to competition, it took 12.7 ± 3.6 months. In pitchers, 47% (18/38) returned to their previous competition levels for at least 1 year, with a KJOC score of 73.7 ± 21.1. Pitchers were able to return to throwing at 6.3 ± 2.3 months and competition at 12.8 ± 3.7 months. Conclusion: Only half of baseball players undergoing UCL revision reconstruction were able to return to their previous levels of competition. Outcomes for revision reconstructions are not as promising as primary procedures. Baseball players should be cautioned that they may not return to their previous levels of play after a revision reconstruction.

Outcomes After Medial Ulnar Collateral Ligament Graft Repair in Professional Baseball Pitchers With Minimum 2-Year Follow-up

“…The same cannot be said after reruptures of the previously reconstructed graft. Andrews et al 1 reported that of a series of 40 pitchers from various levels in an institutional database, 80% were able to return to baseball, but only 47% returned to the same level of competition (reported as a Conway score of excellent). Of the 10 MLB pitchers included in that study, 80% reported excellent Conway scores.…”

“…Our cohort of pitchers returned to professional competition at a mean of 17.0 ± 6 months, consistent with other similar reported series. Andrews et al 1 reported pitchers of all levels returning to competition at a mean of 12.8 ± 3.7 months, while the MLB pitchers took 14.5 months (range, 10-21 months). Camp et al 5 reported that their cohort of professional pitchers returned to the same level of competition at 16.1 ± 3.9 months.…”

“… 5 , 13 , 19 In the largest series on revision UCLRs, Camp et al 4 showed that while 77% of players return to competitive baseball, only 55% return at the same level. Andrews et al 1 showed near-identical findings in a series of 40 baseball players undergoing revision UCLR via the modified Jobe technique, with only 50% able to return to the same level of competition. Previous smaller cohorts demonstrated similar rates of return to play and level of return.…”

Differences in Shoulder Internal Rotation Strength Between Baseball Players With Ulnar Collateral Ligament Reconstruction and Healthy Controls

“…While revision rates may vary among positions in baseball, it is well-established that decreased performance and career longevity are significantly diminished after surgery, making the focus of clinical outcomes after primary UCLR of paramount impact. 3 , 26 …”

“…While revision rates may vary among positions in baseball, it is well-established that decreased performance and career longevity are significantly diminished after surgery, making the focus of clinical outcomes after primary UCLR of paramount impact. 3,26 A number of risk factors for excessive UCL stress and potential UCL injury or reinjury have been identified in the literature: glenohumeral range of motion measures, 16,40 measures of throwing volume, 1,34 kinetic chain deficits, 15,18 and parameters of pitching performance. 2,4,13,29,31,39 Decreases in rotator cuff strength have also been linked to risk for elbow injury.…”