Rehabilitation and Return to Sport Criteria Following Ulnar Collateral Ligament Reconstruction: A Systematic Review

2021 ◽  
pp. 036354652110339
Author(s):  
Bryson R. Kemler ◽  
Somnath Rao ◽  
Donald P. Willier ◽  
Robert A. Jack ◽  
Brandon J. Erickson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Future Research ◽  
Significant Heterogeneity ◽  
Value Assessment ◽  
Collateral Ligament ◽  
Postoperative Rehabilitation ◽  
Level Of Evidence ◽  
Methodologic Quality

Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) is a viable treatment option for patients with UCL insufficiency, especially in the overhead throwing athlete. Within the clinical literature, there is still no universally agreed upon optimal rehabilitation protocol and timing for return to sport (RTS) after UCLR. Hypothesis: There will be significant heterogeneity with respect to RTS criteria after UCLR. Most surgeons will utilize time-based criteria rather than functional or performance-based criteria for RTS after UCLR. Study Design: Systematic review; Level of evidence, 4. Methods: All level 1 to 4 studies that evaluated UCLR with a minimum 1-year follow-up were eligible for inclusion. Studies lacking explicit RTS criteria, studies that treated UCL injury nonoperatively or by UCL repair, or studies reporting revision UCLR were excluded. Each study was analyzed for methodologic quality, RTS, timeline of RTS, and RTS rate. Results: Overall, 1346 studies were identified, 33 of which met the inclusion criteria. These included 3480 athletes across 21 different sports. All studies reported RTS rates either as overall rates or via the Conway-Jobe scale. Timelines for RTS ranged from 6.5 to 16 months. Early bracing with progressive range of motion (ROM) (93.9%), strengthening (84.8%), and participation in an interval throwing program (81.8%) were the most common parameters emphasized in these rehabilitation protocols. While all studies included at least 1 of 3 metrics for the RTS value assessment, most commonly postoperative rehabilitation (96.97%) and set timing after surgery (96.97%), no article completely defined RTS criteria after UCLR. Conclusion: Overall, 93.9% of studies report utilizing bracing with progressive ROM, 84.8% reported strengthening, and 81.8% reported participation in an interval throwing program as rehabilitation parameters after UCLR. In addition, 96.97% reported timing after surgery as a criterion for RTS; however, there is a wide variability within the literature on the recommended time from surgery to return to activity. Future research should focus on developing a comprehensive checklist of functional and performance-based criteria for safe RTS after UCLR.

scholarly journals Treatment of Ulnar Collateral Ligament Tears of the Elbow

2017 ◽  
Vol 5 (1) ◽  
pp. 232596711668221 ◽  
Author(s):  
Brandon J. Erickson ◽  
Bernard R. Bach ◽  
Nikhil N. Verma ◽  
Charles A. Bush-Joseph ◽  
Anthony A. Romeo
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Treatment Method ◽  
Gap Formation ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Internal Bracing ◽  
Repair Techniques

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.

scholarly journals Return-to-Sport Criteria After Upper Extremity Surgery in Athletes—A Scoping Review, Part 2: Ulnar Collateral Ligament of the Elbow Procedures

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110218
Author(s):  
Rebecca Griffith ◽  
Ioanna K. Bolia ◽  
Nickolas Fretes ◽  
Iain R. Murray ◽  
John Meyer ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Upper Extremity ◽  
Scoping Review ◽  
English Language ◽  
Physical Therapists ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Meta Analyses

Background: There is a lack of consensus to guide patient return to sport (RTS) after elbow ulnar collateral ligament surgery (eUCLS). Purpose: To describe the reported RTS criteria after eUCLS in the athletic population. Study Design: Scoping review; Level of evidence, 4. Methods: This scoping review was performed by adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Scoping Review) guidelines. We searched 5 electronic databases (MEDLINE, Scopus, SPORTDiscus, Embase, Google Scholar Advanced) and the gray literature for English-language studies that reported at least 1 RTS criterion in athletes after eUCLS. Data were extracted and summarized as frequencies or arithmetic mean and standard deviation. Results: Included were 14 studies and 1335 athletes with a mean age of 21.4 ± 1.1 years. Time from surgery (range, 6-16 months) was the most common RTS criterion used, and it was reported by all 14 of the included articles. RTS criteria reported less often were pain (3/14; 21%), successful completion of a throwing program (3/14; 21%), muscle strength of the forearm muscles (1/14; 7%), and “normal” range of motion and muscle strength of the elbow and shoulder joints on the operated upper extremity (1/14; 7%). All studies used 1 to 5 of the above RTS criteria. Conclusion: Only 14 studies reported 1 or more RTS criteria after eUCLS in athletes, and time was the most common RTS criterion used. Our results highlight the need for a coordinated effort among surgeons, physical therapists, and athletic trainers in order to establish evidence-based RTS criteria after eUCLS in athletes so athletes can safely to sport and prolong their athletic careers.

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

2018 ◽  
Vol 27 (3) ◽  
pp. 561-571 ◽  
Author(s):  
Scott D. Peters ◽  
Garrett S. Bullock ◽  
Adam P. Goode ◽  
Grant E. Garrigues ◽  
David S. Ruch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Ulnar Collateral Ligament Injury

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 Medial Elbow Pain During the Return-to-Throwing Period After Ulnar Collateral Ligament Reconstruction in Pitchers

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880878
Author(s):  
Robert A. Keller ◽  
Nathan E. Marshall ◽  
Orr Limpisvasti ◽  
Anthony F. DeGiacomo ◽  
Michael Banffy ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Single Institution ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Elbow Pain ◽  
Mean Time ◽  
Control Study ◽  
Ulnar Collateral Ligament Reconstruction

Background: Ulnar collateral ligament reconstruction (UCLR) is common in the sport of baseball, particularly among pitchers. Postoperative return-to-sport protocols have many players beginning to throw at 4 to 5 months and returning to full competition between 12 and 16 months after surgery. Medial elbow pain during the return-to-throwing period often occurs and can be difficult to manage. Purpose: To evaluate the incidence of medial elbow pain and associations with outcomes and revision surgery during the return-to-throwing period after UCLR. Study Design: Case-control study; Level of evidence, 3. Methods: Between the years of 2002 and 2014, all pitchers who underwent UCLR at a single institution were identified. Charts were reviewed for incidence of medial elbow pain during return to throwing, return to sport, and subsequent operative interventions, including revision ulnar collateral ligament surgery. Results: Of a total of 616 pitchers who underwent UCLR during the study period, 317 were included in this study. Medial elbow pain was experienced by 45.1% (143 of 317), with a mean time of complaint of 9.75 months after surgery. The groups with and without pain did not differ statistically with regard to age (pain, 20.6 years; no pain, 20.9 years) or level of competition. Of those who experienced medial elbow pain, 10.5% did not return to sport; 5.6% underwent revision UCLR; and 19.6% underwent other operative procedures at the elbow. Among those who did not experience medial elbow pain when returning to throw, 8.7% did not return to sport, with only 1.7% undergoing revision UCLR and 6.9% undergoing other operative elbow procedures. Conclusion: Of the pitchers evaluated in the study, approximately half reported pain during the return-to-throwing phase after UCLR. Those who experienced medial elbow pain had a higher rate of subsequent surgical intervention.

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.

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.

Postoperative Rehabilitation of Ulnar Collateral Ligament Reconstruction: A Systematic Review

2021 ◽  
Vol 29 (2) ◽  
pp. e9-e17
Author(s):  
Wiemi A. Douoguih ◽  
Jonathan Day ◽  
Ehab A. Bahrun ◽  
Blake M. Bodendorfer ◽  
Christopher Brandt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Postoperative Rehabilitation ◽  
Ulnar Collateral Ligament Reconstruction

scholarly journals Return-to-Sport Outcomes After Primary Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Tendon Grafts: A Systematic Review

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110557
Author(s):  
David P. Trofa ◽  
Michael Constant ◽  
Connor R. Crutchfield ◽  
Nicholas J. Dantzker ◽  
Bryan M. Saltzman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Hamstring Tendon ◽  
Cochrane Library ◽  
Hamstring Graft ◽  
Collateral Ligament ◽  
Palmaris Longus ◽  
The Mean ◽  
Tendon Grafts

Background: Ulnar collateral ligament (UCL) reconstruction is the current gold standard of treatment for overhead athletes with a symptomatic, deficient UCL of the elbow who have failed nonoperative treatment and wish to return to sport (RTS) at a high level. The palmaris longus and hamstring tendons are common graft choices, but no study has analyzed the existing literature to assess whether one graft is superior to the other. Purpose: To systematically report on the outcomes of UCL reconstruction using palmaris and hamstring autografts. Study Design: Systematic review; Level of evidence, 4. Methods: A combination of the terms “ulnar collateral ligament,” “valgus instability,” “Tommy John surgery,” “hamstring,” and “palmaris longus” were searched in PubMed, Embase, and the Cochrane Library. RTS and return-to-same-level (RSL) rates, patient-reported outcomes, and complications were included for analysis. We used the modified Coleman Methodology Score and risk-of-bias tool for nonrandomized studies to assess the quality of the included studies. Results: This review included 6 studies (combined total of 2154 elbows) that directly compared palmaris and hamstring graft use in UCL reconstruction. Follow-up ranged from 24 to 80.4 months, and the mean patient age across all studies was 21.8 years. The mean RSL across all studies and grafts was 79.0%, and the mean RTS was 84.1%, consistent with results previously reported in the literature. The mean RTS and RSL rates for the palmaris graft group were 84.6% and 82%, respectively; the hamstring graft group showed mean RTS and RSL rates of 80.8% and 80.8%. Meta-analysis revealed no significant difference in RSL between the 2 graft groups (odds ratio, 1.06; 95% CI, 0.77-1.46). The combined complication rate of the included studies was 18.2%, with failure rates ranging from 0% to 7.1%. Conclusion: Results of this review indicated that both palmaris and hamstring tendon grafts are viable options for primary UCL reconstruction. Graft choice should be determined by a combination of patient and surgeon preference.

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