United States Trends in Medial Ulnar Collateral Ligament Reconstruction: A retrospective Review of a Large Private-Payer Database from 2007 to 2011

Abstract

Objectives:Purpose: Overuse injuries to the elbow in the throwing athlete are common. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on both recreational and high-level athletes. There is no current literature regarding the incidence and demographic distribution of this surgical procedure in relation to age, location within the Unites States (U.S.), and gender. The purpose of this study is to determine the current demographic distribution of UCLR within the U.S.Methods:Methods: A retrospective analysis of private payer database using the PearlDiver Supercomputer (Warsaw, IN) was performed to identify UCLR procedures performed between the years of 2007-2011. The Current Procedural Code (CPT) 24346 (reconstruction of the ulnar collateral ligament of the elbow with the use of a tendinous graft) was used. Statistical analysis was performed as appropriate using STATA (Version 12.1; Statacorp; College Station, TX, USA).Results:Results: Between 2007-2011, 790 patients underwent UCLR. The overall average annual incidence was 2.16+/- 0.27 per 100,000 patients, but was 31.9 +/-3.9 for patients aged 15-19. The average annual growth was 5.72%. There were 695 males and 95 females. Fifteen to 19 year olds accounted for significantly more procedures than any other age group 56.8% (p<0.001), followed by 20 to 24 year olds 23.4%. The incidence of UCLR in the 15-19 year old group increased at an average rate of 6% per year (incidence rate ratio = 1.06, p=0.025). The south region performed significantly more UCLR than any other region p<0.001. The number of procedures significantly increased over time (p=0.039).Conclusion:Conclusion: UCLR was performed significantly more in patients aged 15-19 than any other age group. The average annual incidence of UCLR per 100,000 people for patients aged 15-19 is 31.9. The number of UCLR is increasing over time. Further work should address risk-reduction efforts in this at-risk population.

Ulnar Collateral Ligament Reconstruction; the Rush Experience

“…3,6,8 The goals of this study were to report the patent demographics, clinical outcomes, return-to-sport rate, and complications for all UCLRs performed at a single institution from January 2004 to December 2014. The most common graft choice in this study was an ipsilateral palmaris longus autograft, used in 59.3% of patients, followed by a hamstring autograft, used in 25.4% of patients (Table 4).…”

“…There has been a trend in the literature toward younger patients undergoing UCLR, with a recent increase in the percentage of high school athletes compared with other levels. 3,8 A recent study on national trends in UCLR between 2007 and 2011 using the Pearl Diver database showed that UCLR was most commonly performed in 15-to 19-year-old patients; 57% of all patients undergoing UCLR fell into this age group. 8 Although injury prevention programs have been instituted over the past decade to protect adolescent athletes from injury, these programs have yet to yield a significant decline in injury rates.…”

“…3,8 A recent study on national trends in UCLR between 2007 and 2011 using the Pearl Diver database showed that UCLR was most commonly performed in 15-to 19-year-old patients; 57% of all patients undergoing UCLR fell into this age group. 8 Although injury prevention programs have been instituted over the past decade to protect adolescent athletes from injury, these programs have yet to yield a significant decline in injury rates. 10,11 Interestingly, this study did not show a significant difference in the yearly timing of UCLR.…”

Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes

“…The rising incidence of ulnar collateral ligament reconstructions performed in young overhead throwing athletes from 1995 to 2015, based on publicly available data of the American Sports Medicine Institute and Erickson (2015) 4. UCL, ulnar collateral ligament.…”

Increased pitch velocity and workload are common risk factors for ulnar collateral ligament injury in baseball players: a systematic review

“…Ulnar collateral ligament (UCL) tears represent one of the most common elbow injuries in baseball players. Evidence suggests that the rate of UCL injuries in baseball players has been rising dramatically in recent years 2. Baseball pitchers put very high amounts of stress through their elbow when pitching.…”