Trends of Ulnar Collateral Ligament Reconstruction in the United States from 2003 to 2014: Analysis of 3,133 Patients

Abstract

Purpose The purpose of this study is to investigate the trends concerning ulnar collateral ligament (UCL) reconstruction (UCLR) for athletic injuries within the United States over the years 2003 to 2014. Methods A retrospective review of the Truven Health Marketscan® Commercial Database was conducted for patients undergoing UCLR. Data was reviewed for patients treated between 2003 and 2014, and the cohort of patients undergoing UCLR was queried using Common Procedural Terminology code 24346. Patients ages 11 to 40 years were included and divided into 6 different age groups, with the rate of UCLR calculated for each group. Results The overall rate of UCLR increased from 4.4 per million in 2003 to 11.9 per million in 2014 ( p < .01). Throughout the same time period, the rate per million increased from 3.3 to 22.1 in 11- to 15-year-olds ( p < .01), from 105.4 to 293.2 in 16- to 20-year-olds ( p < .01), from 23.1 to 67.0 in 21- to 25-year-olds ( p < .01), and from 2.1 to 5.7 in 31- to 35-year-olds ( p < .01). There was no significant increase in the rate of UCLR in the age groups of 26 to 30 and 36 to 40 years. Conclusion UCLR was mostly performed in patients aged 11 to 25 years (96.6%), and specifically most common in those patients aged 16 to 20 years (67.4%). The rate of UCLR procedures increased over time for younger age groups significantly more than for their older counterparts. Clinical Relevance UCLR rates are increasing in young patients despite efforts addressing injury risk reduction strategies and education for coaches, players, and parents regarding risk factors for UCL injury.

The 50 most impactful articles on the medial ulnar collateral ligament: An altmetric analysis of online media

“… 17 Although ACL injuries are commonly sustained in a wide variety of sports, the disproportionately high incidence of medial elbow instability in the United States is expected, given the popularity of baseball and softball. 1 , 69 This notion is further supported by the fact that over half of the MUCL articles in this study were specifically relevant to the sport of baseball, suggesting a much higher level of interest in MUCL injuries among American sports medicine providers and the general public in the United States compared to other geographic regions of the world where baseball is not as popular.…”

“…The incidence of MUCL injury and surgical reconstruction/repair has risen in the United States, where overuse elbow injuries are observed with increasing frequency across the athletic spectrum from youth to professional sports. 1 , 2 In elite overhead athletes, MUCL injury can greatly impact individual on-field performance, career longevity, and overall team success. As a result, conversation about the MUCL within the sphere of high-level athletics often extends beyond healthcare providers to include the mainstream media and the general public.…”

Psychological Factors Associated With Return to Play After Ulnar Collateral Ligament Reconstruction: A Systematic Review

“… 3 , 14 , 19 This finding is noteworthy, as the high school population is one in which a dramatic increase in UCL reconstruction being performed has been seen. 9 , 10 In an analysis of a national insurance database, Idowu et al 10 recently determined that the rate of UCL reconstruction procedures in the United States has increased from 3.3 to 22.1 per million in 11- to 15-year-old patients and from 105.4 to 293.2 per million in 16- to 20-year-old patients from 2003 to 2014. As more high school athletes undergo UCL reconstruction, it is important to understand how psychological factors affect RTP in this population.…”

“…3,14,19 This finding is noteworthy, as the high school population is one in which a dramatic increase in UCL reconstruction being performed has been seen. 9,10 In an analysis of a national insurance database, Idowu et al 10 Specifically, high school athletes may be more prone to loss of interest in returning to play, and some high school athletes may not desire to play at a higher competition level. In this population, it thus becomes crucial for surgeons to carefully evaluate the competition goals of each patient through a comprehensive discussion with the patients and their families at the initial visit.…”

“… 7 Previously established factors affecting RTP include surgical technique, graft fixation technique, level of competition, and sport and position played. 4 , 20 , 21 With the dramatic increase in the number of UCL reconstruction procedures performed annually and the expansion of UCL reconstruction candidates to include younger patient populations, 7 , 9 , 10 it is imperative to more thoroughly understand factors affecting RTP after UCL reconstruction.…”