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

2018 ◽  
Vol 4 (1) ◽  
pp. 41-47
Author(s):  
Ryan P Coughlin ◽  
Yung Lee ◽  
Nolan S Horner ◽  
Nicole Simunovic ◽  
Edwin R Cadet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Injury Prevention ◽  
Ulnar Collateral Ligament ◽  
Quality Data ◽  
Sufficient Evidence ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Baseball Players ◽  
The Impact

ImportanceUlnar collateral ligament (UCL) injuries commonly occur in baseball players. Strategies for injury prevention have long been accepted without clinical data informing which risk factors lead to serious injury.ObjectiveThe objective of this study was to systematically review the impact of various pitching-related risk factors for UCL injury in baseball players from all levels of play.Evidence reviewThe electronic databases MEDLINE, EMBASE and PubMed were systematically searched until 4 March 2018, and pertinent data were abstracted by two independent reviewers. Search terms included ‘ulnar collateral ligament’, ‘medial ulnar collateral ligament’, ‘Tommy John’, ‘risk’ and ‘association’. Inclusion criteria were English-language studies, level of evidence I–IV and studies reporting risk factors for UCL injury of the elbow in baseball players. Study quality was assessed using the methodological index for non-randomised studies (MINORS) criteria. The results are presented in a narrative summary.FindingsPitching practices (workload and pitch characteristics) were reported in 9/15 studies. Specifically, three of four studies (n=1810) reported increased pitch workload as a risk factor for native UCL injury (p<0.001 to 0.02). The most common pitch characteristic reported was pitch velocity with four of five studies showing increased velocity being significantly associated with native UCL injury (p<0.01 to 0.02). Biomechanical risk factors reported were increased humeral retrotorsion (two studies; n=324), poor lower extremity and trunk balance (one study; n=42) and loss of total arc of shoulder motion (two studies; n=118), all significantly associated with UCL injury (p<0.0001 to 0.05). One of three studies assessing pitch workload as a risk factor for re-rupture of UCL reconstruction found a significant association (p<0.01).Conclusions and relevancePitching practices, reflected by increased pitch workload and velocity, were most commonly associated with UCL injury; however, the definition of workload (number of pitches per game, inning or season) was inconsistently reported. Biomechanical risk factors were less commonly reported and lack sufficient evidence to recommend preventative strategies. More quality data is needed to refine the current recommendations for injury prevention in baseball players.Level of evidenceIII.

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

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.

scholarly journals The impact of distance and the crow hop on medial elbow stress during an interval throwing program

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0034
Author(s):  
Austin Cross ◽  
Grace Smith ◽  
Caleb Gulledge ◽  
Dylan Koolmees ◽  
Vasilios Moutzouros ◽  
...  
Keyword(s):  
High School ◽  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Standard Interval ◽  
Rehabilitation Programs ◽  
Ball Velocity ◽  
The Impact ◽  
Ulnar Collateral Ligament Reconstruction

Objectives: Rehabilitation programs following ulnar collateral ligament reconstruction include an interval throwing program in order to gradually increase stress and prevent excessive elbow valgus loads. These programs often instruct players to use the crow hop, even at short distances, in order to reduce stress on the reconstructed ligament. The purpose of the study was to evaluate the impact of the crow hop on medial elbow stress at various distances of an interval throwing program. Methods: High school and college-aged baseball players were recruited for this study. Players threw at distances of 30, 45, 60, 90, 120, 150, and 180 feet. At each distance, participants made 3 throws while using a crow hop and 3 throws without using a crow hop with the instruction to throw on an arc. A wearable device recorded elbow torque, arm slot, arm speed, and shoulder rotation. Ball velocity was measured using radar gun. Results: A total of 20 players participated in this study. Overall elbow torque at each distance was 12.9, 20.5, 26.3, 31.9, 34.7, 36.1, and 37.1 Nm, respectively. There was no difference in elbow stress for throws with a crow hop compared to throws without a crow hop at any distance of throwing (p > 0.05). There was no difference in elbow torque for throws at 150 feet compared to 120 feet (p = 0.10) or 150 feet compared to 180 feet (p = 0.83); however, there were significant increases in elbow torque between every other throwing distance (p < 0.05). Conclusions: Medial elbow torque significantly increases at greater throwing distances of a standard interval throwing program, although the effect becomes less pronounced at longer distances as players maximize effort. The crow hop does not affect medial elbow torque at any distance of throwing.

Ulnar Collateral Ligament Tear Location May Affect Return-to-Sports Rate but Not Performance Upon Return to Sports After Ulnar Collateral Ligament Reconstruction Surgery in Professional Baseball Players

2020 ◽  
Vol 48 (11) ◽  
pp. 2608-2612 ◽  
Author(s):  
Brandon J. Erickson ◽  
James Carr ◽  
Peter N. Chalmers ◽  
Evan Vellios ◽  
David W. Altchek
Keyword(s):  
Ulnar Collateral Ligament ◽  
Nonoperative Treatment ◽  
Professional Baseball ◽  
Return To Sports ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri ◽  
And Performance

Background: The number of ulnar collateral ligament (UCL) tears in professional baseball players is increasing. UCL reconstruction (UCLR) is the treatment of choice in players with failed nonoperative treatment who wish to return to sports (RTS). It is unknown if UCL tear location influences the ability of players to RTS or affects their performance upon RTS. Purpose/Hypothesis: The purpose was to compare the RTS rate and performance upon RTS in professional baseball players who underwent UCLR based on UCL tear location (proximal vs distal). It was hypothesized that no difference in RTS rate or performance upon RTS will exist between players with proximal or distal UCL tears. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent primary UCLR by a single surgeon between 2016 and 2018 were eligible for inclusion. Players with purely midsubstance tears or revision UCLR were excluded. Tear location was determined based on preoperative magnetic resonance imaging (MRI) and intraoperative findings. RTS rate and performance were compared between players with proximal versus distal UCL tears. Results: Overall, 25 pitchers (15 proximal and 10 distal tears) and 5 position players (2 proximal and 3 distal) underwent primary UCLR between 2016 and 2018. Of the 25 pitchers, 84% were able to RTS. Of the 5 position players, 80% were able to RTS. Among the total cohort of pitchers and position players, 12 out of 17 (71%) players with proximal tears were able to RTS, while of the 13 distal tears, 13 out of 13 (100%) players were able to RTS ( P = .05). With regard to performance data, pitchers with distal tears had higher utilization postoperatively and, as such, allowed statistically more hits ( P = .03), runs ( P = .015), and walks ( P = .021) postoperatively. However, the WHIP ([walks + hits]/innings pitched) was not different between players with proximal or distal tears, indicating that efficacy in games was not significantly different between groups. Conclusion: Professional baseball players who sustain a distal UCL tear and undergo UCLR may be more likely to RTS than those who sustain a proximal UCL tear and undergo UCLR. Players with distal UCL tears who underwent UCLR saw higher utilization postoperatively than those with proximal UCL tears. Further work is needed in this area to confirm this result.

Ulnar collateral ligament reconstruction of the elbow at minimum 48-month mean follow-up demonstrates excellent clinical outcomes with low complication and revision rates: systematic review

2021 ◽  
pp. jisakos-2021-000614
Author(s):  
Martin S Davey ◽  
Eoghan T Hurley ◽  
Mohamed Gaafar ◽  
John G Galbraith ◽  
Hannan Mullett ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Patient Reported ◽  
The Mean

ImportanceTears of the ulnar collateral ligament (UCL) of the elbow occur predominantly as an overuse injury, most commonly affecting throwing athletes, particularly baseball players. UCL reconstruction (UCLR) has been described as an effective treatment modality in the short term.ObjectiveThe purpose of this study was to systematically review the evidence in the literature to ascertain the clinical outcomes, complication and revision rates in baseball players following UCLR of the elbow at a minimum of 48 months of follow-up.Evidence reviewTwo independent reviewers performed a search of the literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the EMBASE, PubMed and Scopus databases. Clinical studies were included if they reported outcomes of baseball players at a minimum of 48 months following UCLR.FindingsOur review included 8 studies including 1104 baseball players (1105 elbows) at mean 69.9 months (48–205) following UCLR. The majority of baseball players were pitchers (92.3%), with a mean age of 22.2 years (13–42). At final follow-up, the overall return to play (RTP) was 95.3%%, with 85.3% returning at pre-injury level. In addition, the mean reported Conway-Jobe score was 86.8%, the revision rate was 6.0% with postoperative neuropathy reported in 2.4% of patients. A total of 479 (43.4%) were professional baseball players, with an overall RTP rate of 97.5% and 82.3% managing to RTP at their pre-injury level. The mean number of career years following UCLR was 4.7 years (0–22).Conclusion and relevanceUCLR provides excellent patient-reported and clinical outcomes to patients at medium-term follow-up with low complication and revision rates. In addition, high rates of RTP at pre-injury level and career longevity were reported by baseball players following UCLR.Level of evidenceLevel IV; Systematic Review

scholarly journals Prevalence of Medial Ulnar Collateral Ligament Surgery in 6135 Current Professional Baseball Players: A 2018 Update

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987144 ◽  
Author(s):  
Devin P. Leland ◽  
Stan Conte ◽  
Nancy Flynn ◽  
Nicholas Conte ◽  
Ken Crenshaw ◽  
...  
Keyword(s):  
United States ◽  
Ulnar Collateral Ligament ◽  
The United States ◽  
Professional Baseball ◽  
Published Data ◽  
Collateral Ligament ◽  
Online Questionnaire ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Baseball Players

Background: As the incidence of ulnar collateral ligament (UCL) surgery continues to rise rapidly, an update on the current prevalence and demographics in professional baseball players is warranted. Hypothesis: The prevalence of UCL reconstruction in Major League Baseball (MLB) and Minor League Baseball (MiLB) players will be higher than that previously reported, and the increase in prevalence will be most notable in MiLB pitchers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: During the 2018 baseball season, an online questionnaire regarding a history of UCL surgery was distributed to the certified athletic trainers of all 30 MLB organizations. These trainers then administered the survey to all players within their organizations, including MLB, MiLB (AAA, AA, High A, Low A, High Rookie, Low Rookie), and Dominican Summer League (DSL) players. Demographics were compared between MLB, MiLB, and DSL players. Results of this 2018 survey were compared with previously published data from the 2012 season to assess the change over time. Results: There were 6135 professional baseball players who completed the survey (66% response rate). The prevalence of UCL reconstruction in all MLB and MiLB players was 13% (637/4928), while the prevalence in DSL players was 2% (20/1207) ( P < .001). The prevalence in all MLB and MiLB players (13%) and pitchers (20%) both increased significantly from 2012 ( P < .001). MLB pitchers reported a higher prevalence of UCL reconstruction than did MiLB pitchers (26% vs 19%, respectively; P < .001). In 2018, the prevalence of UCL reconstruction has increased significantly in MiLB pitchers (19% vs 15%, respectively; P < .001) and pitchers aged 21 to 30 years (22% vs 17%, respectively; P < .001) compared with 2012. Additionally, United States–born pitchers were more likely to have undergone UCL reconstruction compared with Latin America–born pitchers (23% vs 13%, respectively; P < .001). Conclusion: The prevalence of UCL reconstruction has increased significantly in professional baseball players over the past 6 years from 10% to 13%. Ultimately, the prevalence of UCL reconstruction has increased most significantly since 2012 in MiLB pitchers, pitchers aged 21 to 30 years, and pitchers born in the United States.

Epidemiology of Elbow Ulnar Collateral Ligament Injuries Among Baseball Players: National Collegiate Athletic Association Injury Surveillance Program, 2009-2010 Through 2013-2014

2018 ◽  
Vol 46 (9) ◽  
pp. 2142-2147 ◽  
Author(s):  
Steven F. DeFroda ◽  
Avi D. Goodman ◽  
Joseph A. Gil ◽  
Brett D. Owens
Keyword(s):  
Risk Factors ◽  
National Collegiate Athletic Association ◽  
Ulnar Collateral Ligament ◽  
Injury Surveillance ◽  
Return To Play ◽  
Surveillance Program ◽  
Characteristic Analysis ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Significant Difference

Background: Injuries to the ulnar collateral ligament (UCL) of the elbow are of major concern in baseball; however, the epidemiology of these injuries among National Collegiate Athletic Association (NCAA) athletes is poorly described. Purpose: To determine the incidence of UCL injuries in NCAA baseball and investigate the risk factors involved. Study Design: Descriptive epidemiology study. Methods: All UCL injuries for academic years 2009-2010 through 2013-2014 were extracted from the NCAA Injury Surveillance Program database. The incidence was calculated for different positions, activity, time in game, competition status, and injury characteristics and compared via injury risk ratios to determine risk factors for injury occurrence. The NCAA provides sampling weights based on division and year. For all other injury characteristic analysis, unweighted data were used. Results: Over the course of the 2009-2010 to 2013-2014, 20 UCL injuries were reported in the NCAA Injury Surveillance Program over 177,992 athletic exposures (AEs) for an overall incidence of 1.12 per 10,000 AEs (95% CI, 0.63-1.62). Eighty-five percent occurred during throwing, and 100% were new injuries. Of the injuries sustained during games, 28.6% occurred early (warm-up through third inning) and 71.4% late (fourth inning or later), with a risk ratio of 1.3 for late-game injuries (95% CI, 0.24-6.44). Of those injured, 45.0% were able to return to play by the next season, while the remainder were out for at least 7 days. Injury was season ending for 15% of athletes (0.17 per 10,000 AEs), and 15% of athletes required surgery. Conclusion: UCL injury is a potentially season-ending, even career-ending, injury among NCAA baseball players. Additionally, while more injuries occurred later in games, the current study revealed no significant difference in injury rates with respect to time in game. Last, the authors found a higher reported rate of extensive time away from sport after UCL injury than previously published studies on this patient population.

scholarly journals Return-to-Play and Competitive Outcomes After Ulnar Collateral Ligament Reconstruction Among Baseball Players: A Systematic Review

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096631
Author(s):  
Stephen J. Thomas ◽  
Ryan W. Paul ◽  
Adam B. Rosen ◽  
Sam J. Wilkins ◽  
Joseph Scheidt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Decision Making ◽  
Ulnar Collateral Ligament ◽  
Clinical Decision ◽  
Return To Play ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Competitive Outcomes ◽  
Performance Statistics

Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) is very common in baseball. However, no review has compared the return-to-play (RTP) and in-game performance statistics of pitchers after primary and revision UCLR as well as of position players after UCLR. Purpose: To review, synthesize, and evaluate the published literature on outcomes after UCLR in baseball players to determine RTP and competitive outcomes among various populations of baseball players. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search including studies between 1980 and November 4, 2019, was conducted for articles that included the following terms: ulnar collateral ligament, elbow, medial collateral ligament, Tommy John surgery, throwing athletes, baseball pitchers, biomechanics, and performance. To be included, studies must have evaluated baseball players at any level who underwent UCLR (primary or revision) and assessed RTP and/or competitive outcomes. Results: A total of 29 studies with relatively high methodological quality met the inclusion criteria. After primary UCLR, Major League Baseball (MLB) pitchers returned to play in 80% to 97% of cases in approximately 12 months; however, return to the same level of play (RTSP) was less frequent and took longer, with 67% to 87% of MLB pitchers returning in about 15 months. RTP rates for MLB pitchers after revision UCLR were slightly lower, ranging from 77% to 85%, while RTSP rates ranged from 55% to 78%. RTP rates for catchers (59%-80%) were generally lower than RTP rates for infielders (76%) and outfielders (89%). All studies found a decrease in pitching workloads after UCLR. Fastball usage may also decrease after UCLR. Changes in earned run average and walks plus hits per inning pitched were inconclusive. Conclusion: Pitchers returned to play after UCLR in approximately 12 months and generally took longer to return to their same level of play. Pitchers also returned to play less frequently after revision UCLR. After both primary and revision UCLR, professional pitchers experienced decreased workloads and potentially decreased fastball usage as well. Catchers may RTP after UCLR less frequently than pitchers, infielders, and outfielders possibly because of the frequency of throwing in the position. These results will help guide clinical decision making and patient education when treating UCL tears in baseball players.

Effect of Predraft Ulnar Collateral Ligament Reconstruction on Future Performance in Professional Baseball: A Matched Cohort Comparison

2018 ◽  
Vol 46 (6) ◽  
pp. 1459-1464 ◽  
Author(s):  
Christopher L. Camp ◽  
Stan Conte ◽  
John D’Angelo ◽  
Stephen A. Fealy ◽  
Christopher S. Ahmad
Keyword(s):  
Ulnar Collateral Ligament ◽  
Time Frame ◽  
Annual Number ◽  
Professional Baseball ◽  
Control Analysis ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Entire Study ◽  
Elbow Surgery

Background: In recent years, there has been a dramatic rise in the annual number of ulnar collateral ligament (UCL) reconstructions performed in amateur baseball pitchers. Accordingly, increasing numbers of players are entering professional baseball having already undergone the procedure; however, the effect of prior UCL reconstruction on future success remains unknown. Purpose: (1) To provide an epidemiologic report on baseball players who undergo UCL reconstruction before being selected in the Major League Baseball (MLB) Draft, (2) to define the outcomes in terms of statistical performance, and (3) to compare these results with those of matched controls (ie, non–UCL reconstruction). Study Design: Cohort study; Level of evidence, 3. Methods: The MLB Amateur Draft Database was queried to identify all drafted pitchers who underwent UCL reconstruction before being drafted. For each pitcher drafted from 2005 to 2014 with prior UCL reconstruction, 3 healthy controls with no history of elbow surgery were randomly identified for matched analysis. A number of demographic and performance comparisons were made between these groups. Results: A total of 345 pitchers met inclusion criteria. The annual number of pitchers undergoing predraft UCL reconstructions rose steadily from 2005 to 2016 ( P < .001). For matched control analysis, 252 pitchers with a UCL reconstruction and a minimum 2-year follow-up (drafted between 2005 and 2014) were matched to 756 controls (non–UCL reconstruction). As compared with the non–UCL reconstruction group, pitchers who underwent predraft UCL reconstruction reached the MLB level with greater frequency (20% vs 12%, P = .003), and their MLB statistical performances were similar for all measures. Compared with all other pitchers drafted during that period, players who had a predraft UCL reconstruction demonstrated an increased likelihood of reaching progressive levels of play (Full Season A, AA, and MLB) within a given time frame ( P < .05 for all). Conclusion: The number of UCL reconstructions performed in amateur baseball players before the draft increased year over year for the entire study period. Professional pitchers who underwent UCL reconstruction as amateurs appear to perform at least as well as, if not better than, matched controls without elbow surgery.

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