The success of return to sport after ulnar collateral ligament injury in baseball: a systematic review and meta-analysis

Background: Ulnar collateral ligament (UCL) tears have become common, and UCL reconstruction (UCLR) is currently the preferred surgical treatment method for treating UCL tears. Purpose/Hypothesis: The purpose of this study was to review the literature surrounding UCL repair and determine the viability of new repair techniques for treatment of UCL tears. We hypothesized that UCL repair techniques will provide comparable results to UCLR for treatment of UCL tears. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed with PRISMA guidelines using 3 publicly available free databases. Biomechanical and clinical outcome investigations reporting on UCL repair with levels of evidence 1 through 4 were eligible for inclusion. Descriptive statistics were calculated for each study and parameter/variable analyzed. Results: Of the 46 studies eligible, 4 studies (3 clinical and 1 biomechanical) were included. There were 92 patients (n = 92 elbows; 61 males [62.3%]; mean age, 21.9 ± 4.7 years) included in the clinical studies, with a mean follow-up of 49 ± 14.4 months. Eighty-six percent of repairs performed were on the dominant elbow, and 38% were in college athletes. Most UCL repairs (66.3%) were performed via suture anchors. After UCL repair, 87.0% of patients were able to return to sport. Overall, 94.9% of patients scored excellent/good on the Andrews-Carson score. Patients who were able to return to sport after UCL repair did so within 6 months after surgery. Biomechanically, when UCL repair was compared with the modified Jobe technique, the repair group showed significantly less gap formation than the reconstruction group. Conclusion: In patients for whom repair is properly indicated, UCL repair provides similar return-to-sport rates and clinical outcomes with shorter return-to-sport timing after repair compared with UCL reconstruction. Future outcome studies evaluating UCL repair with internal bracing are necessary before recommending this technique.

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The role of ultrasonography in the assessment of ulnar collateral ligament injury of the thumb – a diagnostic test accuracy meta-analysis

Journal of Plastic Surgery and Hand Surgery ◽

10.1080/2000656x.2020.1838295 ◽

2020 ◽

pp. 1-13

Author(s):

Firas J. Raheman ◽

Djamila M. Rojoa ◽

Mohit Dhingra ◽

Saad Siddiqui ◽

Christopher R. Macdonald

Keyword(s):

Diagnostic Test ◽

Meta Analysis ◽

Ulnar Collateral Ligament ◽

Diagnostic Test Accuracy ◽

Ligament Injury ◽

Test Accuracy ◽

Collateral Ligament ◽

Ulnar Collateral Ligament Injury

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Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis

European Radiology ◽

10.1007/s00330-020-07666-z ◽

2021 ◽

Author(s):

Ali Rashidi ◽

Arya Haj-Mirzaian ◽

Danoob Dalili ◽

Benjamin Fritz ◽

Jan Fritz

Keyword(s):

Systematic Review ◽

Clinical Examination ◽

Meta Analysis ◽

Ulnar Collateral Ligament ◽

Metacarpophalangeal Joint ◽

Evidence Based ◽

Collateral Ligament

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Ultrasound Imaging of Ulnar Collateral Ligament Injury

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2016.0420 ◽

2016 ◽

Vol 46 (12) ◽

pp. 1086-1086 ◽

Cited By ~ 1

Author(s):

Arie J. van Duijn ◽

Shawn D. Felton

Keyword(s):

Ultrasound Imaging ◽

Ulnar Collateral Ligament ◽

Ligament Injury ◽

Collateral Ligament ◽

Ulnar Collateral Ligament Injury

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Effect of Younger Starting Pitching Age on Humeral Retrotorsion in Baseball Pitchers With an Ulnar Collateral Ligament Injury

The American Journal of Sports Medicine ◽

10.1177/0363546521990808 ◽

2021 ◽

pp. 036354652199080

Author(s):

Sean M. Kennedy ◽

Joseph P. Hannon ◽

John E. Conway ◽

Kalyssa Creed ◽

J. Craig Garrison

Keyword(s):

Ulnar Collateral Ligament ◽

Ligament Injury ◽

Collateral Ligament ◽

Level Of Evidence ◽

Baseball Players ◽

Significant Difference ◽

Ulnar Collateral Ligament Injury ◽

Baseball Pitchers ◽

Group 2 ◽

Group 1

Background: Increased humeral retrotorsion (HRT) has been found to be a risk factor for ulnar collateral ligament (UCL) tears in baseball players. Recent work has demonstrated the age of 11 years as a potential watershed age for HRT development. Hypothesis: In a group of baseball pitchers with UCL injuries, athletes who started pitching before the age of 10 years will demonstrate significantly more dominant limb humeral retrotorsion (DHRT) when compared with a group of baseball pitchers who reported starting pitching at 10 years or older. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 84 baseball pitchers with a diagnosed UCL injury were divided into 2 groups based upon the age at which participants began pitching: 33 players reporting a starting pitching age of 10 years or older (group 1) were compared with 51 baseball pitchers reporting a starting pitching age under 10 years (group 2). Participants’ DHRT and nondominant limb humeral retrotorsion (NDHRT) were measured using diagnostic ultrasound. Independent t tests were run to compare mean group differences of all patient data, starting pitching age, age at time of injury, DHRT, NDHRT, and humeral retrotorsion difference (HRTdiff). Results: There were no significant differences between groups with regard to age at time of injury, height, weight, or playing years’ experience. There was a statistically significant difference in the participant-reported starting pitching age. Significant differences between groups were noted for DHRT (group 1: 20.0°± 9.4°, group 2: 14.5°± 10.3°, P = .015) and for NDHRT (group 1: 38.6°± 8.8°, group 2: 32.9°± 9.5°, P = .007). No significant differences between groups were found for HRTdiff ( P = .940). Conclusion: Baseball pitchers with a UCL injury who reported a starting pitching age younger than 10 years demonstrated significantly greater DHRT and NDHRT when compared with UCL-injured baseball pitchers who reported a starting pitching age at 10 years or later. The results of this study demonstrate that a younger starting pitching age results in increased HRT in players with UCL injuries.

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