Nonsurgical Management of Ulnar Collateral Ligament Injuries is Tentatively Successful in Overhead Athletes: A Critical Appraisal of Case Series

2020 ◽  
Vol 25 (5) ◽  
pp. 213-220
Author(s):  
Nathan Oakes ◽  
Jennifer M. Medina McKeon
Keyword(s):  
Odds Ratio ◽  
Critical Appraisal ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Overhead Athletes ◽  
Nonsurgical Management ◽  
Ligament Rupture

Since its inception, surgical management of the ulnar collateral ligament (UCL) is fairly standard; however, the invasive, costly, and time-intensive nature of UCL surgery may be restrictive to some athletes. Electronic databases were searched starting from the year 2013 to September 2018. Extracted data included frequencies of (a) return to play (RTP); (b) return to same level of play (RTSP); (c) athlete’s position; (d) complete reconstitution of the UCL; and (e) the location of ligament rupture (proximal or distal). Proportions of success/failure for selected outcomes were calculated. Additionally, an odds ratio (OR) (95% confidence interval [CI]) determined the association between tear location (proximal vs. distal) and nonsurgical success. A total of 169 athletes underwent nonsurgical management of UCL injury in the seven included studies. Sports included baseball, gymnastics, softball, hockey, volleyball, and tennis. Overall, 83% (n = 140) were able to RTP and 72% (n = 121) were able to RTSP. Those with proximal UCL tears had a RTSP rate of 82% (n = 56) compared to 42% (n = 13) of those with a distal tear. Proximal tears were associated with higher rates of successful outcomes in RTP and RTSP (OR = 6.5 [2.5,16.7], p < .001). In baseball, 76% (n = 38) of pitchers were able to RTSP compared to 90% (n = 9) of position players. When visualized using MRI, 96% (n = 22) of athletes had full UCL reconstitution following nonsurgical management. Based on the pooled outcomes of included studies, nonsurgical management of a UCL injury was reasonably successful for RTP and RTSP rates in professional athletes, with a better chance of success for proximal tears compared to distal and incomplete tears compared to complete. The exploratory nature of utilizing nonsurgical management for UCL sprains in athletes, by way of the case series, appears to be fairly well established, but an upgrade in study design is warranted.

scholarly journals Medial Ulnar Collateral Ligament Repair With Internal Brace Augmentation: Results in 40 Consecutive Patients

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110142
Author(s):  
Robert O’Connell ◽  
Marcus Hoof ◽  
John Heffernan ◽  
Michael O’Brien ◽  
Felix Savoie
Keyword(s):  
Functional Outcomes ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Orthopaedic Clinic ◽  
Overhead Athletes ◽  
Internal Brace ◽  
The Mean

Background: Medial ulnar collateral ligament (MUCL) repair has been proven to be effective in nonprofessional overhead-throwing athletes, with faster and higher rates of return to play (RTP) than the more traditional Tommy John reconstruction. Biomechanical studies and clinical data suggest that MUCL repair augmented with a collagen-coated internal brace may be an effective treatment option in this patient population. Purpose: To evaluate the functional outcomes of young nonprofessional athletes who underwent MUCL repair with internal brace augmentation for medial elbow instability. The hypothesis was that these patients will have high rates of RTP and improved functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: Nonprofessional overhead athletes treated with MUCL repair with internal brace augmentation between 2015 and 2017 were prospectively evaluated for a minimum of 1 year. Preoperatively, all patients had evidence of medial elbow pain caused by MUCL insufficiency, as confirmed by signal changes on magnetic resonance imaging and valgus instability on arthroscopic examination. These findings did not allow them to participate in their chosen sport or profession, and each patient had failed nonoperative treatment. Postoperative outcomes were evaluated using the Overhead Athlete Shoulder and Elbow Score of the Kerlan-Jobe Orthopaedic Clinic. Complications were recorded and detailed. Results: A total of 40 nonprofessional overhead athletes were included in this study (35 men and 5 women; mean age, 17.8 years [range, 14-28 years]). The mean follow-up time was 23.8 months (range, 12-44 months). The mean postoperative Kerlan-Jobe Orthopaedic Clinic score was 92.6 (range, 64-100). Overall, 37 athletes (92.5%) returned to play or profession at the same level or higher at a mean time of 6.9 months (range, 2-12 months). Three patients did not RTP: 1 was limited by a concomitant medical diagnosis, and the other 2 chose not to resume athletics after the procedure but remained symptom free. Conclusion: In the nonprofessional athlete, primary MUCL repair with internal brace augmentation is a viable alternative to traditional repair techniques or reconstruction, allowing for a rapid RTP and promising functional outcomes.

Outcomes After Ulnar Collateral Ligament Revision Reconstruction in Baseball Players

2020 ◽  
Vol 48 (13) ◽  
pp. 3359-3364
Author(s):  
James R. Andrews ◽  
Vikram Venkateswaran ◽  
Kevin D. Christensen ◽  
Hillary A. Plummer ◽  
Karen M. Hart ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Excellent Result ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Overhead Athletes ◽  
Patient Reported ◽  
Revision Reconstruction

Background: There is a lack of evidence regarding the success of ulnar collateral ligament (UCL) revision reconstruction. Understanding outcomes after UCL revision reconstruction is important in clinical decision making for overhead athletes. Purpose: To evaluate return to play and patient-reported outcomes after UCL revision reconstruction. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent UCL revision reconstruction, attributed to retear of the ligament or pain, between June 2004 and July 2016 at 2 surgical centers were identified. Charts were reviewed for age, sex, date of primary and revision reconstruction, sport played, level of play, graft type, and complications. Patients were contacted by telephone to determine time to return to play, current level of participation, Conway score, Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, and satisfaction. Results: Of the 65 consecutive baseball players who underwent revision UCL reconstruction, 40 (62%) were contacted at a minimum 22 months after surgery. Of these, 38 (95%) were pitchers and 2 (5%) were position players. Time to return to throwing was 6.2 ± 2.3 months (mean ± SD), and the KJOC score was 74.2 ± 20.7. Based on the Conway score, 50% (20/40) had an excellent result, indicating a return to the previous competition level for at least 1 year, and 30% (12/40) had a good result, indicating a return to a lower level for at least 1 year. For those who were able to return to competition, it took 12.7 ± 3.6 months. In pitchers, 47% (18/38) returned to their previous competition levels for at least 1 year, with a KJOC score of 73.7 ± 21.1. Pitchers were able to return to throwing at 6.3 ± 2.3 months and competition at 12.8 ± 3.7 months. Conclusion: Only half of baseball players undergoing UCL revision reconstruction were able to return to their previous levels of competition. Outcomes for revision reconstructions are not as promising as primary procedures. Baseball players should be cautioned that they may not return to their previous levels of play after a revision reconstruction.

Ulnar Collateral Ligament Repair With Collagen-Dipped FiberTape Augmentation in Overhead-Throwing Athletes

2019 ◽  
Vol 47 (5) ◽  
pp. 1096-1102 ◽  
Author(s):  
Jeffrey R. Dugas ◽  
Christopher A. Looze ◽  
Brian Capogna ◽  
Brian L. Walters ◽  
Christopher M. Jones ◽  
...  
Keyword(s):  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Final Decision ◽  
Collateral Ligament ◽  
Tissue Quality ◽  
Level Of Evidence ◽  
Overhead Athletes ◽  
Novel Technique ◽  
Internal Brace

Background: There has been a renewed interest in ulnar collateral ligament (UCL) repair in overhead athletes because of a greater understanding of UCL injuries, an improvement in fixation technology, and the extensive rehabilitation time to return to play. Purpose/Hypothesis: To evaluate the clinical outcomes of a novel technique of UCL repair with internal brace augmentation in overhead throwers. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing a novel technique of UCL repair with internal brace augmentation were prospectively followed for a minimum of 1 year. Potential candidates for repair were selected after the failure of nonoperative treatment when imaging suggested a complete or partial avulsion of the UCL from either the sublime tubercle or medial epicondyle, without evidence of poor tissue quality of the ligament. The final decision on UCL repair or traditional reconstruction was determined intraoperatively. Demographic and operative data were collected at the time of surgery. Return to play, and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores were collected at 1 year and then again at 2 years postoperatively. Results: Of the 111 overhead athletes eligible for the study, 92% (102/111) of those who desired to return to the same or higher level of competition were able to do so at a mean time of 6.7 months. These patients had a mean KJOC score of 88.2 at final follow-up. Conclusion: UCL repair with internal brace augmentation is a viable option for amateur overhead throwers with selected UCL injuries who wish to return to sport in a shorter time frame than allowed by traditional UCL reconstruction.

scholarly journals Direct Comparison of Modified Jobe and Docking Ulnar Collateral Ligament Reconstruction at Midterm Follow-up

2018 ◽  
Vol 47 (1) ◽  
pp. 144-150 ◽  
Author(s):  
Justin W. Arner ◽  
Edward S. Chang ◽  
Stephen Bayer ◽  
James P. Bradley
Keyword(s):  
Reconstructive Surgical Procedures ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Shoulder Injuries ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Overhead Athletes ◽  
Additional Surgery ◽  
Significant Difference

Background: The modified Jobe and docking techniques are the 2 most commonly employed techniques for ulnar collateral ligament (UCL) reconstruction among overhead athletes. However, no study has directly compared these techniques performed by a single surgeon. Current comparisons of these techniques have relied solely on systematic reviews and biomechanical studies. Hypothesis: There will be no difference in outcomes or return to play between the modified Jobe and docking techniques in elbow UCL reconstruction surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-five modified Jobe and 26 docking UCL-reconstructive surgical procedures were performed by a single surgeon, each with a minimum 2-year follow-up. Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway Scale, years played, sex, handedness, sport, position, palmaris versus gracilis graft type, concomitant or future arm/shoulder injuries, and need for additional surgery were compared between the groups. Patients who underwent future shoulder or elbow surgery, no matter the cause, were included. Results: No difference was seen between the modified Jobe and docking reconstruction cases in regard to KJOC scores (mean ± SD: 78.4 ± 19.5 vs 72.0 ± 26.0, P = .44), Conway Scale (return to play, any level: 84% vs 82%, P = .61), years played (14.7 ± 6.2 vs 15.2 ± 5.8, P = .52), sex ( P = .67), handedness ( P ≥ .999), sport ( P = .44), position ( P = .60), level of competition ( P = .59), and future surgery (12% vs 4%, P = .35). Palmaris graft type had significantly higher KJOC scores than hamstring grafts (82.3 ± 20.0 vs 57.9 ± 21.2, P = .001). The mean follow-up was 6.1 years in the modified Jobe group and 7.3 years in the docking group (mean = 6.7, P = .47). Conclusion: The modified Jobe and docking techniques are both suitable surgical options for elbow UCL reconstruction. There was no statistically significant difference between the techniques in regard to return to play, KJOC score, or need for subsequent surgery at 6.7-year follow-up. This is the first direct clinical comparison of these 2 techniques by a single surgeon at midterm follow-up.

scholarly journals Nonsurgical Management of Ulnar Collateral Ligament Injuries

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Hasani W. Swindell ◽  
David P. Trofa ◽  
Frank J. Alexander ◽  
Julian J. Sonnenfeld ◽  
Bryan M. Saltzman ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Nonsurgical Management

scholarly journals Trends in Sports-Related Elbow Ulnar Collateral Ligament Injuries

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773129 ◽  
Author(s):  
Jason L. Zaremski ◽  
JoAnna McClelland ◽  
Heather K. Vincent ◽  
MaryBeth Horodyski
Keyword(s):  
Odds Ratio ◽  
Injury Severity ◽  
Ulnar Collateral Ligament ◽  
International Classification Of Diseases ◽  
Collateral Ligament ◽  
Surgical Interventions ◽  
Injury Management ◽  
Nonsurgical Management ◽  
Older Athletes ◽  
Partial Tears

Background: Elbow ulnar collateral ligament (UCL) injuries are common, particularly in adolescent athletes playing overhead sports. While the incidence and outcomes of surgical UCL injuries are well documented, the nonsurgical UCL injury patterns and injury management in this population are not yet known. Purpose/Hypothesis: The purpose of this study was to retrospectively assess the injury severity and subsequent management of UCL injuries among competitive athletes aged 11 to 22 years. We hypothesized that nonsurgical UCL injuries would occur more frequently in younger athletes compared with older athletes. Study Design: Descriptive epidemiological study. Methods: Electronic medical records (using International Classification of Diseases, 9th Revision and 10th Revision and Current Procedural Terminology codes) and keyword searches were used to identify all patients with sports-related UCL injuries between January 2000 and April 2016. A total of 136 records were included. Patients were stratified into 3 age brackets (age 11-13 years, n = 17; age 14-16 years, n = 49; age 17-22 years, n = 70). There were no prior elbow surgical interventions. The main outcome measures included the frequency and severity of UCL injuries and injury management (surgical, nonsurgical). Independent variables included age, UCL injuries per year, and sport classification. Results: There were 53 surgical and 83 nonsurgical UCL injuries. The number of nonsurgical cases increased 9-fold from 2000-2008 to 2009-2016. The UCL injuries were distributed as follows: 60 sprains, 39 partial tears, 36 ruptures, and 1 rerupture. Moreover, 7% of sprains, 51% of partial tears, and 78% of ruptures underwent UCL reconstruction. Nonsurgical management was most common in the youngest athletes (age 11-13 years, 100.0% of total injuries; age 14-16 years, 71.4% of total injuries; and age 17-22 years, 44.3% of total injuries) ( P = .007). UCL injury volume was most commonly associated with javelin (odds ratio, 6.69; 95% CI, 0.72-61.62; P = .07) and baseball (odds ratio, 1.55; 95% CI, 0.69-3.51; P = .32). Conclusion: Younger athletes sustained less severe UCL injuries more often than older athletes. Participation in javelin and baseball was associated with a greater likelihood of UCL injuries based on our dataset. This is the first study to provide data on the volume of nonsurgical UCL injuries among athletes in various sports.

scholarly journals Biologic Augmentation of the Ulnar Collateral Ligament in the Elbow of a Professional Baseball Pitcher

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
James K. Hoffman ◽  
Nicole M. Protzman ◽  
Amit D. Malhotra
Keyword(s):  
Platelet Rich Plasma ◽  
Present Report ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Surgical Reconstruction ◽  
Professional Baseball ◽  
Collateral Ligament ◽  
Overhead Athletes ◽  
Baseball Pitcher ◽  
Professional Baseball Pitcher

Tears of the ulnar collateral ligament (UCL) of the elbow are common injuries in overhead athletes. Although surgical reconstruction of the UCL has improved outcomes, not all athletes return to their previous level of competition and when this goal is achieved, the time required averages one to two years. Therefore, additional techniques are needed to further improve return to play and the rate of return to play in overhead athletes. A construct comprising a dermal allograft, platelet rich plasma (PRP), and mesenchymal stem cells (MSCs) has been shown to successfully improve healing in the rotator cuff. Given the promising provisional findings, we postulated that this construct could also improve healing if applied to the UCL. Therefore, the purpose of the present report was to examine the feasibility of utilizing a dermal allograft, PRP, and MSC construct to augment UCL reconstruction in a professional baseball pitcher. No complications were encountered. Although limited to minimal follow-up, the patient has demonstrated excellent progress and has returned to activity.

Injuries to the Collateral Ligaments of the Metacarpophalangeal Joint of the Thumb, Including Simultaneous Combined Thumb Ulnar and Radial Collateral Ligament Injuries, in National Football League Athletes

2016 ◽  
Vol 45 (1) ◽  
pp. 195-200 ◽  
Author(s):  
Brian C. Werner ◽  
Nicole S. Belkin ◽  
Steve Kennelly ◽  
Leigh Weiss ◽  
Ronnie P. Barnes ◽  
...  
Keyword(s):  
Physical Examination ◽  
National Football League ◽  
Surgical Repair ◽  
Case Series ◽  
Injury Pattern ◽  
Return To Play ◽  
Ligament Injury ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Radial Collateral Ligament

Background: Thumb collateral ligament injuries occur frequently in the National Football League (NFL). In the general population or in recreational athletes, pure metacarpophalangeal (MCP) abduction or adduction mechanisms yield isolated ulnar collateral ligament (UCL) and radial collateral ligament (RCL) tears, respectively, while NFL athletes may sustain combined mechanism injury patterns. Purpose: To evaluate the incidence of simultaneous combined thumb UCL and RCL tears among all thumb MCP collateral ligament injuries in NFL athletes on a single team. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all thumb injuries on a single NFL team from 1991 to 2014 was performed. All players with a thumb MCP collateral ligament injury were included. Collateral ligament injuries were confirmed by review of both physical examination findings and magnetic resonance imaging. Player demographics, surgical details, and return-to-play data were obtained from the team electronic medical record and surgeons’ records. Results: A total of 36 thumbs in 32 NFL players were included in the study, yielding an incidence of 1.6 thumb MCP collateral ligament injuries per year on a single NFL team. Of these, 9 thumbs (25%) had a simultaneous combined UCL and RCL tear injury pattern confirmed on both physical examination and MRI. The remaining 27 thumbs (75%) were isolated UCL injuries. All combined UCL/RCL injuries required surgery due to dysfunction from instability; 63.0% of isolated UCL injuries required surgical repair ( P = .032) due to continued pain and dysfunction from instability. Repair, when required, was delayed until the end of the season. All players with combined UCL/RCL injuries and isolated UCL injuries returned to play professional football the following season. Conclusion: Simultaneous combined thumb UCL and RCL tear is a previously undescribed injury pattern that occurred in 25% of thumb MCP collateral ligament injuries on a single NFL team over a 23-year period. All players with combined thumb UCL/RCL injuries required surgical repair, which was significantly higher compared with players with isolated UCL injuries. Team physicians and hand surgeons treating elite football players with suspected thumb collateral ligament injuries should examine for RCL and UCL instability and consider MRI if any concern exists for a combined ligament injury pattern, as this injury is likely frequently missed.

scholarly journals Outcomes after Elbow Ulnar Collateral Ligament Reconstruction with the Docking Plus Technique in 163 Athletes

2020 ◽  
Author(s):  
Marc Lubitz ◽  
Benjamin Donohue ◽  
Vadim Molla ◽  
Timothy Kremchek
Keyword(s):  
Case Series ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
High Volume ◽  
Return To Play ◽  
College Level ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Before And After ◽  
High Level

Abstract Background: This retrospective case series examined 163 athletes who underwent ulnar collateral ligament (UCL) reconstruction (UCLR) from 2015-2018. All cases were by a single surgeon at a high volume center using the Docking Plus Technique. We previously reported outcomes in 324 athletes from 2005-2014 with 88% of patients reporting a Conway score of good or excellent. Purpose/Hypothesis: The purpose of this study was to determine if patients undergoing UCLR with the docking plus technique are able to return to sport and to better characterize the athletes needing this procedure. Our hypothesis was that our cohort would largely be able to return to their previous level of play and be mostly college level pitchers. Methods: Patients who underwent UCLR at our institution from 2015-2018 were identified and surveyed. We were able to reach a total of 163 patients and they were asked for background demographic information and information about their athletic careers before and after UCLR. Results: Our results were largely similar to our previously study with 94.5% of athletes obtaining Conway scores of Good or Excellent. 95% of athletes were male, 91% played baseball, and 83% of baseball players were pitchers. 59% of athletes were in college at the time of their surgery. For 8 athletes, this was a revision procedure, 7 of the revisions were for pitchers. 5 of the 7 pitchers were able to get back to the same level or higher of competition. 98.8% of patients surveyed said they were “satisfied with the outcome of the surgery.” Conclusions: The Docking Plus Technique performed by a single surgeon at a private practice setting leads to reproducible return to play and patient satisfaction. The prototypical patient undergoing UCLR is a high level male baseball pitcher. UCL outcomes data would benefit from more prospective studies and the creation of a nationwide UCLR database to draw conclusions about technique, graft type, risk factors, and many more relevant variables.

scholarly journals Considerations of Conservative Treatment After a Partial Ulnar Collateral Ligament Injury in Overhead Athletes: A Systematic Review

2019 ◽  
Vol 11 (4) ◽  
pp. 367-374
Author(s):  
Nicole Cascia ◽  
Kelsey Picha ◽  
Carolyn M. Hettrich ◽  
Tim L. Uhl
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Study Design ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Evidence Based ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Rehabilitation Protocol ◽  
Overhead Athletes

Context: Ulnar collateral ligament (UCL) reconstructions continue to increase without consensus on an evidence-based treatment protocol for nonoperative management. Currently, there is no consensus on an effective nonoperative protocol for partial UCL injuries that uses return-to-play (RTP) rates in determining the outcome of conservative treatment. Objective: To systematically review RTP rates after conservative treatment of partial UCL injuries in overhead athletes along with descriptive components of each conservative intervention to identify an effective evidence-based nonoperative rehabilitation protocol. Data Sources: Articles in PubMed, CINAHL, MEDLINE, Academic Search Complete, and SPORTDiscus were identified in October 2018 based on the following terms: overhead athlete, ulnar collateral ligament, nonoperative treatment, and return to play. Study Selection: Seven retrospective, level 4 studies (n = 196) qualified for analysis. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Study design, level of evidence, demographics, sample size, sports involved, level of competition, grade or type of UCL diagnosis, conservative treatment components, and percentage RTP were extracted. Results: Overall, RTP rates after conservative treatment ranged between 42% and 100% (mean, 78% ± 20%). The most frequently reported components of rehabilitation protocols were (1) a period of rest, (2) stretching, (3) strengthening, and (4) a throwing program. Platelet-rich plasma injections were included in 5 (71%) of the 7 protocols with a rehabilitation period. Conclusion: Conservative treatment is a viable option for partial UCL tears in overhead athletes. A successful rehabilitation protocol includes the use of patient-reported outcomes, a sport-specific tailored treatment plan, kinetic chain strengthening, and an interval throwing program. Factors such as age, grading of tear, level of play, sport, and athlete’s perceived well-being should all be considered during treatment decisions.

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