Return-to-Sport Criteria After Upper Extremity Surgery in Athletes—A Scoping Review, Part 2: Ulnar Collateral Ligament of the Elbow Procedures

Abstract

Background: There is a lack of consensus to guide patient return to sport (RTS) after elbow ulnar collateral ligament surgery (eUCLS). Purpose: To describe the reported RTS criteria after eUCLS in the athletic population. Study Design: Scoping review; Level of evidence, 4. Methods: This scoping review was performed by adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Scoping Review) guidelines. We searched 5 electronic databases (MEDLINE, Scopus, SPORTDiscus, Embase, Google Scholar Advanced) and the gray literature for English-language studies that reported at least 1 RTS criterion in athletes after eUCLS. Data were extracted and summarized as frequencies or arithmetic mean and standard deviation. Results: Included were 14 studies and 1335 athletes with a mean age of 21.4 ± 1.1 years. Time from surgery (range, 6-16 months) was the most common RTS criterion used, and it was reported by all 14 of the included articles. RTS criteria reported less often were pain (3/14; 21%), successful completion of a throwing program (3/14; 21%), muscle strength of the forearm muscles (1/14; 7%), and “normal” range of motion and muscle strength of the elbow and shoulder joints on the operated upper extremity (1/14; 7%). All studies used 1 to 5 of the above RTS criteria. Conclusion: Only 14 studies reported 1 or more RTS criteria after eUCLS in athletes, and time was the most common RTS criterion used. Our results highlight the need for a coordinated effort among surgeons, physical therapists, and athletic trainers in order to establish evidence-based RTS criteria after eUCLS in athletes so athletes can safely to sport and prolong their athletic careers.

Workload Comparison of Contemporary Interval Throwing Programs and a Novel Optimized Program for Baseball Pitchers

“…However, there was no consensus on how much time was adequate for rehabilitation before returning, with time frames ranging from 4-16 months. 38 Conversely, in a separate systematic review the most common return to play criterion was completion of an ITP (87%; 13 out of 15 studies) and found players started the ITP on average 16.7 weeks after surgery (range 12-18 weeks). 39 The optimal wait period following injury or surgery to initiate an ITP is likely highly individualized.…”

“…37 Many factors can influence the ideal time course for initiating an ITP, such as time from surgery, level of competition, time of season, surgeon's preference, and successful progression through physical therapy. In a recent review, Griffith et al 38 included 14 studies tracking return to sport (RTS) after UCLr and reported time from surgery was the most common RTS criterion used and was reported in 100% of the studies. However, there was no consensus on how much time was adequate for rehabilitation before returning, with time frames ranging from 4-16 months.…”