Return-to-Competition Criteria After Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis

Abstract

Background: Injury to the ulnar collateral ligament of the elbow is common among overhead throwing athletes and can result in significant functional limitations. While surgical reconstruction offers high rates of return to competition, there are no validated or universally accepted guidelines for determining when an athlete can safely resume play. Purpose: To assess the existing scientific literature for return-to-competition criteria utilized after ulnar collateral ligament reconstruction. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: The PubMed database was searched for clinical investigations of ulnar collateral ligament reconstruction in overhead throwing athletes published between January 2000 and June 2020. Only studies that had a minimum follow-up of 1 year and included at least 1 specific return-to-competition criterion were considered. Results: A total of 15 studies were included in the final analysis, encompassing 1156 patients with an average age of 20.7 years (SD, 2.0 years). Baseball players composed 96.3% of patients for whom sport was specified, and 92.4% of baseball players were pitchers. The most common return-to-competition criterion, identified in 87% of studies, was completion of a return-to-throwing program, which started on average 16.7 weeks (range, 12-18 weeks) after surgery. A return-to-mound program was utilized in 53% of studies, starting on average 7.4 months (range, 6-9 months) postoperatively. Minimum time from surgery was used in 73% studies, with players waiting 7 to 12 months (mean, 9.7; SD, 1.4 months) after surgery before return-to-competition consideration. The overall rate of return to competition at the preinjury level or higher was 85.7% (SD, 8.5%) at an average of 12.2 months (SD, 0.6 months). Conclusion: In general, we observed a paucity of literature describing the return-to-competition process after ulnar collateral ligament reconstruction in overhead throwing athletes. Only 3 explicit return-to-competition criteria were identified across all studies: completion of a return-to-throwing program, completion of a return-to-mound program for pitchers, and minimum time from surgery. Increased transparency regarding postoperative rehabilitation protocols and further research are necessary to identify and validate sport-specific return-to-competition criteria, which will ultimately help athletes return to play in a safe and timely fashion after ulnar collateral ligament reconstruction.

Factors Important to Patient Decision-Making After Ulnar Collateral Ligament Injury in Competitive High School and Collegiate Baseball Players

“…Pitchers return around 12 to 14 months versus 9 to 11 months for position players after UCL reconstruction. 1,4 This discrepancy in length of rehabilitation seems to be smaller after UCL repairs. Pitchers returned at on average 7.3 months versus 7.1 months for position players after UCL repair in a study by Dugas et al 6 Being a pitcher rather than a position player was "very" or "extremely important" in the decision-making of 68% of respondents in this study.…”

“…Position players typically return to play at around 6 months after a UCL repair, 6,7,13,17 as compared with 9 to 12 months after a UCL reconstruction. 1,12 The anticipated length of recovery also depends on whether the patient is a pitcher and wants to return to pitching. Pitchers return around 12 to 14 months versus 9 to 11 months for position players after UCL reconstruction.…”

Tommy John: Elbow Ulnar Collateral Ligament Allograft Reconstruction With Internal Brace

“…Ulnar collateral ligament (UCL) injuries of the elbow are most often a result of intense valgus forces placed on the elbow and frequently occur in young overhead athletes. 1 , 2 Injury occurs during late cocking and acceleration phases of throwing in such athletes as baseball pitchers. 1 The first reconstruction technique, performed by Dr. Frank Jobe, was made famous by notable Major League Baseball player Tommy John, who underwent the original “Tommy John” procedure to reconstruct his UCL in 1974.…”

Systematic Assessment of the Quality and Comprehensibility of YouTube Content on Ulnar Collateral Ligament Injury and Management

“…4 Absent or negligible use of unexplained medical jargon (nearly 0% of concepts explained solely with the use of medical jargon); highly appropriate for patient education…”