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.

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 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 Clinical Utility of an MRI-Based Classification System for Operative Versus Nonoperative Management of Ulnar Collateral Ligament Tears: A 2-Year Follow-up Study

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983978 ◽  
Author(s):  
Prem N. Ramkumar ◽  
Heather S. Haeberle ◽  
Sergio M. Navarro ◽  
Salvatore J. Frangiamore ◽  
Lutul D. Farrow ◽  
...  
Keyword(s):  
Classification System ◽  
Odds Ratio ◽  
Clinical Utility ◽  
Nonoperative Management ◽  
Ulnar Collateral Ligament ◽  
Nonoperative Treatment ◽  
Rehabilitation Program ◽  
Collateral Ligament ◽  
Baseball Players

Background: A recently introduced classification system of medial ulnar collateral ligament (UCL) tears accounting for location and severity has demonstrated high interobserver and intraobserver reliability, but little is known about its clinical utility. Purpose: The primary purpose of this study was to assess the relationship of the magnetic resonance imaging (MRI)–based classification system in predicting which athletes had success with nonoperative versus operative treatment after completing a standardized rehabilitation program. A secondary objective included return to play (RTP) and return to prior performance (RPP) analyses of baseball players. Study Design: Cohort study; Level of evidence, 3. Methods: After an a priori power analysis, 58 consecutive patients with UCL tears and a minimum of 2-year follow-up were retrospectively divided into 2 groups: those who successfully completed operative treatment and those who completed nonoperative treatment. The MRI-based classification stages accounting for UCL tear location and severity were compared between the nonoperative and operative groups. A subanalysis for baseball players, including RTP and RPP, was performed. Results: A total of 58 patients (40 baseball players [34 pitchers]) met inclusion criteria. Of these patients 35 (32 baseball players [27 pitchers]) underwent surgery, and 23 (8 baseball players [7 pitchers]) underwent nonoperative management. No patients in the nonoperative arm crossed over to surgery after completing the rehabilitation program. Patients with distal tears (odds ratio, 48.0; P = .0004) and complete tears (odds ratio, 5.4; P = .004) were more likely to undergo surgery. Baseball players, regardless of position, were confounding determinants of operative management, although there was no difference in RTP and RPP between treatment arms. Conclusion: A 6-stage MRI-based classification system addressing UCL tear location and severity may help early decision making, as patients likely to fail nonoperative treatment have complete, distal tears, whereas those with proximal, partial tears may be more amenable to nonoperative management.

Medial Elbow Instability Resulting From Partial Tears of the Ulnar Collateral Ligament: Stress Ultrasound in a Cadaveric Model

2020 ◽  
Vol 48 (11) ◽  
pp. 2613-2620
Author(s):  
Michael C. Ciccotti ◽  
Sommer Hammoud ◽  
Christopher C. Dodson ◽  
Steven B. Cohen ◽  
Levon N. Nazarian ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Nonoperative Treatment ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Diagnostic Modality ◽  
Partial Tear ◽  
Partial Tears ◽  
Early Reconstruction ◽  
Anterior Posterior

Background: There is consensus that most complete ulnar collateral ligament (UCL) injuries in throwers would benefit from surgical intervention. Optimal treatment for partial UCL tears remains controversial. Stress ultrasonography has become a well-accepted diagnostic modality for assessing UCL injury. Hypothesis: Partial UCL tears will result in an intermediate increase in ulnohumeral joint space gapping as compared with that of an intact UCL and a complete UCL tear, but the degree of joint space gapping will vary by anatomic location of the partial tear. Study Design: Controlled laboratory study. Methods: Twenty-one cadaveric elbows were divided into 7 groups representing different anatomic locations of UCL partial tears. Partial tears were simulated by cutting 50% of the measured width of the UCL at 6 locations: distal anterior/posterior, midsubstance anterior/posterior, and proximal anterior/posterior. A seventh partial tear was created by partially elevating the undersurface of the distal UCL to simulate the radiographic “T-sign.” Valgus stress (15 daN) was applied to each cadaveric elbow at 30° of flexion using a standardized device. Each specimen was tested intact, partially torn, and completely torn. At each state, joint space was measured using stress ultrasonography, and the difference in joint space from unstressed to stressed (delta) was recorded. Results: There were 10 right and 11 left upper extremity specimens. The mean delta was 0.58 mm for the intact state and <0.75 mm in all groups. Both distal partial tear groups had mean deltas <0.75 mm, similar to intact elbows. Proximal tears and the T-sign demonstrated intermediate deltas (0.99-1.23 mm). Midsubstance partial tears demonstrated the largest deltas (1.57-2.03 mm), similar to those of the complete tears. All complete tear groups had a mean delta >1.5 mm (1.54-3.03 mm). Conclusion: These findings suggest that partial tears introduce a spectrum of instability from functionally intact to completely torn. As a result, some may be biomechanically amenable to nonoperative treatment, while others would be indicated for early reconstruction. Further research into the biological and biomechanical determinants of nonoperative treatment failure will assist with more precise treatment recommendations. Clinical Relevance: Describing the biomechanical consequences of different, clinically significant partial UCL tears potentially allows more precise recommendations for operative and nonoperative treatment.

scholarly journals Clinical Value of an Acute Popping Sensation in Throwing Athletes With Medial Elbow Pain for Ulnar Collateral Ligament Injury

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989327
Author(s):  
Rik J. Molenaars ◽  
Michel P.J. van den Bekerom ◽  
Mark R. Nazal ◽  
Denise Eygendaal ◽  
Luke S. Oh
Keyword(s):  
Likelihood Ratio ◽  
Injury Severity ◽  
Positive Likelihood Ratio ◽  
Ulnar Collateral Ligament ◽  
Senior Author ◽  
Low Grade ◽  
High Grade ◽  
Full Thickness ◽  
Collateral Ligament ◽  
Elbow Pain

Background: Throwing athletes sustaining an ulnar collateral ligament (UCL) injury may recall a popping sensation originating from the medial elbow at the time of injury. There are no studies available that inform clinicians how to utilize this salient anamnestic information and what amount of diagnostic weight to afford to it. Purpose: To assess the diagnostic value of a popping sensation for significant UCL injury in throwing athletes who sustained an injury causing medial elbow pain. Study Design: Cohort study (prognosis); Level of evidence, 3. Methods: A total of 207 consecutive patients with throwing-related medial elbow pain were evaluated for UCL injury by the senior author between 2011 and 2016. The presence or absence of a popping sensation was routinely reported by the senior author. Magnetic resonance imaging was evaluated for UCL injury severity and classified into intact, edema/low-grade partial-, high-grade partial-, and full-thickness tears. Results: The overall frequency of a pop was 26%. The proportion of patients who reported a pop significantly increased with UCL tear severity ( P < .001), from 13% in patients with low-grade UCL injuries to 26% in patients with high-grade partial-thickness tears and 51% in patients with full-thickness tears. The positive likelihood ratio, negative likelihood ratio, and odds ratio of a popping sensation for significant UCL injury were 3.2, 0.7, and 4.4 ( P < .001), respectively ( P < .001). A pop was not associated with either distal or proximal UCL tears ( P ≥ .999). Conclusion: A popping sensation at the time of injury in throwing athletes with medial elbow pain was associated with UCL injury severity. When a throwing athlete reports a pop, this should moderately increase a clinician’s suspicion for a significant UCL injury. Conversely, absence of a pop should not substantially decrease suspicion for significant UCL injury. The findings of this study allow for the clinical interpretation of the salient anamnestic finding of a pop at the time of injury, which can be used for diagnostic purposes as well as patient counseling. This study provides reference foundation for future studies of predictive and diagnostic factors for UCL injury in throwing athletes.

scholarly journals MAGNETIC RESONANCE IMAGING FINDINGS ASSOCIATED WITH ULNAR COLLATERAL LIGAMENT TEARS IN ADOLESCENT BASEBALL PITCHERS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0007
Author(s):  
Ben Cox ◽  
Hillary Plummer ◽  
Eric Goodrich ◽  
James Andrews ◽  
Michael Saper
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ulnar Collateral Ligament ◽  
High Grade ◽  
Type Ii ◽  
Resonance Imaging ◽  
Collateral Ligament ◽  
Plain Radiographs ◽  
Partial Tears ◽  
Baseball Pitchers

BACKGROUND: The number of ulnar collateral ligament (UCL) injuries in adolescent baseball pitchers has risen over the past 2 decades with the incidence of UCL reconstructions also increasing dramatically over that time period. The Joyner-Andrews magnetic resonance imaging (MRI) classification of UCL tears has previously been described to describe the grade and location of tears, which can aid in surgical decision-making. However, the classification of UCL tears in the at-risk adolescent population has yet to fully investigated. Improving our knowledge of these injuries is crucial to help drive targeted evidence-based treatment strategies. The purpose of this study was to examine the grade and location UCL tears using the Joyner-Andrews MRI classification in a large group of adolescent baseball pitchers. METHODS: We reviewed 225 symptomatic adolescent (aged =19 years) male baseball pitchers with UCL injuries treated by the senior author from 2007-2016. All patients had failed conservative treatment prior to evaluation. Pitchers with a prior history of elbow surgery were excluded. Plain radiographs and MRI arthrograms were evaluated for each patient to categorize the UCL injury and associated pathology. The images were reviewed by a sports medicine-trained orthopedic surgeon. UCL tear grade and location were classified using the Joyner-Andrews classification. RESULTS: The mean age at the time of evaluation was 17.2 ± 1.5 years. 56% of the patients were high school athletes. The majority (59.1%) of UCL tears were high-grade partial tears (Type II). Of those 53.4% were on the humeral side (Type II H). The least common tear types were low-grade partial tears (I) and tears in more than one location (Type IV) in 1.3% and 0.9% of patients, respectively. Plain radiographs revealed 31.4% of patients had abnormal findings; calcifications and olecranon osteophytes were present in 10% and 13% of patients, respectively and more commonly occurred in patients with Type II tears. CONCLUSIONS: The results of this study showed that the majority of adolescent baseball pitchers (59%) sustain high-grade partial tears of the UCL. These findings suggest that effective non-reconstruction options such as platelet-rich plasma and UCL repair with internal brace augmentation could be ideal alternatives to UCL reconstruction for these young patients. The high percentage of radiographic abnormalities in these patients highlights the adaptive changes about the elbow in response to the repetitive stresses experienced by the young elbow during throwing.

Sign in / Sign up

Export Citation Format

Share Document