UCL Injury in the Non-throwing Athlete

Abstract

Purpose of Review Primarily reported in the overhead throwing athlete, ulnar collateral ligament (UCL) injuries have been extensively studied since Dr. Frank Jobe first described his technique for ulnar collateral ligament reconstruction on professional baseball pitcher Tommy John. While the framework for our understanding of UCL injury was initially established studying the repetitive valgus loading of the throwers' elbow, other sport-related activities in non-throwing athletes can impart similar valgus stress on the medial elbow placing the UCL at risk for injury. The purpose of this review is to evaluate the current literature on UCL injury specifically in the non-throwing athlete. Recent Findings In the four decades since Dr. Jobe's seminal description of UCL reconstruction, an abundance of literature has been published on UCL injury in the throwing athlete. The evidence evaluating the UCL specifically in the non-throwing athlete, however, is quite scarce. Several small retrospective studies have demonstrated good results with high rates of return to play with focused rehabilitation and non-operative management in non-throwing athletes. Recent evidence has also demonstrated that surgical repair and/or reconstruction of the UCL in this population can produce good outcomes. Summary The level of evidence of these published studies is low and consists primarily of case series without control groups. Further investigation is warranted to determine the optimal treatment algorithm for UCL injury in the non-throwing athlete. Keywords Ulnar collateral ligament injury. Non-throwing athlete. Non-operative treatment. Ulnar collateral ligament repair. Ulnar collateral ligament reconstruction This article is part of the Topical Collection on Injuries in Overhead Athletes

Mechanical properties and microstructural organization of common ulnar collateral ligament grafts: Palmaris longus and gracilis tendons

“…While the vast majority of UCL injuries occur in the throwing athlete, studies have found that other athletes such as football players, gymnasts, tennis players, and wrestlers have undergone reconstructions. In nonathlete populations, although nonoperative management can successfully treat UCL injuries, surgical intervention has also high rates of success and return to activity, especially populations not partaking in overhead athletic activities 13 . As the number of UCL injuries increases, it is important to improve upon the available techniques for UCLR to optimize the performance of these reconstructions and potentially shorten the recovery time after surgery.…”

“…In nonathlete populations, although nonoperative management can successfully treat UCL injuries, surgical intervention has also high rates of success and return to activity, especially populations not partaking in overhead athletic activities. 13 As the number of UCL injuries increases, it is important to improve upon the available techniques for UCLR to optimize the performance of these reconstructions and potentially shorten the recovery time after surgery. UCLR using either palmaris longus (PL) or gracilis (GR) tendons is the mainstay of treatment for UCL injuries that fail to improve with rest and physical therapy.…”

Clinical Outcomes of Ulnar Collateral Ligament Surgery in Nonthrowing Athletes

“…§ The literature is surprisingly scarce on clinical outcomes after UCL surgery in nonthrowing athletes. 21,24,28,33 These few studies often contain small numbers of nonthrowing athletes with variable outcomes. Jones et al 17 included 3 gymnasts in their publication on UCL reconstruction using the docking technique; their study had a total of 55 athletes, with the remainder being baseball players (n = 47) and javelin throwers (n = 5).…”

“…15 Recent literature has demonstrated improvements in the surgical technique and expected outcomes after UCL surgery. 1-12,16-37 Most publications have involved baseball players, who perform repetitive overhead motions that create chronic valgus stress on the UCL. § Repetitive high loads applied to the UCL during throwing may lead to serious injury, as described in previous biomechanical studies.…”

“…‖ The investigation of UCL injury in nonthrowing athletes has been limited, despite these athletes representing a large portion of patients who sustain surgical UCL injuries. 21,24,28,33 In an epidemiological study by Zaremski et al, 37 nonthrowing athletes represented 27% of patients treated for UCL injury over a 16-year span. The injury pattern in these athletes was less often attritional and more commonly an acute traumatic event.…”