Outcomes and Return to Sport After Ulnar Collateral Ligament Reconstruction in Adolescent Baseball Players

Abstract

Background:The number of ulnar collateral ligament (UCL) reconstructions in adolescent athletes has increased over the past 2 decades. Clinical results in this population have not been well studied.Purpose/Hypothesis:The purpose of this study was to evaluate the outcomes and return to sport after UCL reconstruction in a large group of adolescent baseball players. We hypothesized that excellent clinical outcomes and high rates of return to sport would be observed in this population at a minimum 2-year follow-up.Study Design:Case series; Level of evidence, 4.Methods:We reviewed 140 adolescent (aged ≤19 years) baseball players who underwent UCL reconstruction with the American Sports Medicine Institute (ASMI) technique by a single surgeon. Medical records were reviewed for patient demographics, injury characteristics, operative details, and surgical complications. Patient-reported outcomes were assessed using the Conway scale, the Andrews-Timmerman (A-T) score, the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, and a 0- to 100-point subjective scale for elbow function and satisfaction. Return to sporting activity was assessed using a custom-designed questionnaire.Results:The mean age at the time of surgery was 18.0 years (range, 13-19 years), and the mean follow-up was 57.9 months (range, 32.4-115.4 months). Over half (60%) of patients were high school athletes. The mean duration of symptoms before surgery was 6.9 months (range, 0.5-60.0 months). Partial tears were identified in 57.9% of patients, and 41.3% of patients had preoperative ulnar nerve symptoms. Graft type included the ipsilateral palmaris in 77.1% of patients. Concomitant procedures were performed in 25% of patients. Outcomes on the Conway scale were “excellent” in 86.4% of patients. The mean A-T and KJOC scores were 97.3 ± 6.1 and 85.2 ± 14.6, respectively. Mean patient satisfaction was 94.4. Overall, 97.8% of patients reported returning to sport at a mean of 11.6 months (range, 5-24 months), and 89.9% of patients returned to sport at the same level of competition or higher. A total of 11.6% of patients went on to play professional baseball.Conclusion:UCL reconstruction with the ASMI technique is an effective surgical option in adolescents, with excellent outcome scores. At a minimum of 2-year follow-up, nearly 90% of patients returned to their preinjury level of sport.

Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes

“…RTP time was reported for the docking technique in 3 articles 29,30,35 and for the figure-of-8 studies technique (all modified Jobe) in 4 articles. 10,17,39,44…”

“…Routine ulnar nerve transposition for all patients was reported in 9 studies utilizing the figure-of-8 technique—subcutaneously in 7 studies 1,3,10,17,34,37,39 and submuscularly in 2 studies. 13,28 No authors reported routine ulnar nerve transposition for patients in whom a docking reconstruction was performed.…”

Cross-cultural adaptation and validation of the Kerlan-Jobe orthopedic clinic shoulder and elbow score for German-speaking overhead athletes

“…However, most of them assess activities of daily living (ADL) whereas high-functioning overhead athletes often only notice symptoms or discomfort during sport-specific loading (Gallagher et al, 2017). The Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score (Alberta et al, 2010) is one of the most widely used, valid, and reliable clinical outcome measures that is specific to the shoulder and elbow joint in overhead athletes (Merolla, Paladini, and Porcellini, 2018;Peduzzi et al, 2019;Saper et al, 2018). The KJOC is a patient-administered questionnaire consisting of 10 items to measure the functional status of the upper extremity in this high-functioning population.…”

Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow: Biomechanical Comparison of a Novel Anatomic Technique to the Docking Technique

“…18,22,23,38,44 While this return-to-play (RTP) rate is quite favorable, the mean time to RTP is 12 to 18 months. 6,7,13,27,46 This extended time frame is problematic for patients, as they miss at least 1 full season of play and often miss 2 full seasons following surgery. Additionally, Erickson et al 21 demonstrated that there is no significant difference in the time to return to sport between professional baseball pitchers who required a revision UCL reconstruction and those who did not.…”