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.

Side of Hamstring Harvest Does Not Affect Performance, Return-to-Sport Rate, or Future Hamstring Injuries After Ulnar Collateral Ligament Reconstruction Among Professional Baseball Pitchers

2019 ◽  
Vol 47 (5) ◽  
pp. 1111-1116 ◽  
Author(s):  
Brandon J. Erickson ◽  
Peter N. Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Christopher S. Ahmad ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Ligament Reconstruction ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Professional Baseball ◽  
Hamstring Autograft ◽  
Collateral Ligament ◽  
Injury Rates ◽  
Hamstring Injuries ◽  
Ulnar Collateral Ligament Reconstruction

Background: Ulnar collateral ligament reconstruction (UCLR) is a successful procedure among professional baseball pitchers. It is unclear if hamstring tendon harvest side for UCLR affects the outcome or alters the risk for subsequent hamstring injury. Hypothesis: Players with prior UCLR with ipsilateral (drive leg) hamstring autograft will have the same return-to-sport (RTS) rate and performance upon RTS but a higher number of subsequent lower extremity injuries than those with contralateral (landing leg) hamstring autograft. Study Design: Cohort study; Level of evidence, 3. Methods: All players between 2010 and 2015 who underwent UCLR with hamstring autograft were included. Surgical details of their procedures were recorded from operative reports. Outcomes for UCLR with hamstring autograft harvested from the drive leg were compared with UCLR with the graft harvested from the landing leg. Results: Overall, 191 players underwent UCLR with hamstring autograft (drive leg, n = 58, 30%; landing leg, n = 133, 70%). The docking technique was more common in the drive leg group, while the figure-of-8 technique was more common in the landing leg group ( P > .001). More patients in the landing leg group underwent concomitant treatment of the ulnar nerve than the drive leg group ( P < .001). No difference existed in RTS rates or timing of RTS between groups. No differences in subsequent ipsilateral or contralateral hamstring injuries occurred between players who underwent UCLR with hamstring autograft from the drive leg or the landing leg ( P≥ .999 and P = .460, respectively). No difference in overall upper or lower extremity injury rates existed between groups (all P > .05), and no difference in performance metrics existed between groups upon RTS. Conclusion: No difference in RTS rate, performance upon RTS, or subsequent injury rates (hamstring, lower extremity, or upper extremity) existed between players who underwent UCLR with hamstring autograft whether the graft came from the drive or the landing leg.

scholarly journals Reasons for Retirement Following Ulnar Collateral Ligament Reconstruction Among Major League Baseball Pitchers

2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774502 ◽  
Author(s):  
Brandon J. Erickson ◽  
Junyoung Ahn ◽  
Peter N. Chalmers ◽  
Christopher S. Ahmad ◽  
Bernard R. Bach ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Control Group ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Elbow Injury ◽  
Major League ◽  
History Of ◽  
Ulnar Collateral Ligament Reconstruction

Background: Ulnar collateral ligament reconstruction (UCLR) has become an increasingly common procedure among Major League Baseball (MLB) pitchers. The long-term effects of this procedure on the career of an MLB pitcher are largely unknown. Purpose/Hypothesis: The purpose of this study was to determine why and when MLB pitchers who underwent UCLR during their careers retired from baseball as compared with controls. We hypothesized that pitchers who underwent UCLR are no more likely than control pitchers to retire from elbow or shoulder problems. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All MLB pitchers who underwent UCLR were identified through publicly available data. A cohort of pitchers who did not undergo UCLR were matched to pitchers with a history of UCLR, based on sex, age, draft year, and draft round. Of those who were no longer pitching in the MLB, the reason for retirement was determined. Reason for retirement and length of career following UCLR (surgical group) and index year (control group) were determined and compared through prior studies via the MLB HITS database, MLB team websites, and publicly available internet-based injury reports. Results: Overall, 153 MLB pitchers who underwent UCLR between 1974 and 2015 are currently retired. Mean ± SD time to retirement was 4.4 ± 4.7 years (range, 0-26 years) after the index year in the control group and 4.4 ± 3.5 years (range, 0-15 years) after surgery in the UCLR group ( P = .388). Patients who were status post-UCLR were significantly more likely to be released during the season (34 of 144, 23.6%) than were players who were not status post-UCLR (14 of 144, 9.7%) ( P = .002). Shoulder injury as a reason for retirement was more common in the control group than the UCLR group ( P = .011). Elbow injury as a reason for retirement was not more common in either group ( P = .379). Leg injury as a reason for retirement was more common in the control group ( P = .013). Performance as a reason for retirement was more common in the UCLR group than the control group ( P < .001). Conclusion: MLB pitchers who have undergone UCLR are no more likely to retire from shoulder or elbow injuries than are those who have not undergone UCLR. MLB career length was similar between pitchers with and without a history of UCLR.

Hamstring Injuries in Major League Baseball Pitchers: Implications in Graft Selection for Ulnar Collateral Ligament Reconstruction

2018 ◽  
Vol 47 (2) ◽  
pp. 444-450
Author(s):  
Daniel R. Howard ◽  
Michael B. Banffy ◽  
Neal S. ElAttrache
Keyword(s):  
Ligament Reconstruction ◽  
Major League Baseball ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Hamstring Tendons ◽  
Mechanism Of Injury ◽  
Collateral Ligament ◽  
Leg Injuries ◽  
Hamstring Injuries ◽  
Ulnar Collateral Ligament Reconstruction

Background: Hamstring tendons are commonly harvested as autograft for ulnar collateral ligament reconstruction. There is no consensus in the literature whether the hamstring tendon should be harvested from the ipsilateral (drive) leg or contralateral (landing) leg of baseball pitchers undergoing ulnar collateral ligament reconstruction. Hamstring injuries commonly occur in baseball players, but there are no reports on their incidence specifically among Major League Baseball (MLB) pitchers, nor are there reports on whether they occur more commonly in the drive leg or the landing leg. Hypothesis: Hamstring injuries occur more commonly in the landing legs of MLB pitchers. Study Design: Descriptive epidemiology study. Methods: MLB pitchers who sustained hamstring injuries requiring time spent on the disabled list were identified from publicly available sources over 10 seasons. Demographics of the pitchers and injury and return-to-sport data were collected. Hamstring injuries to the drive leg were compared with injuries to the landing leg. Results: Sixty-five pitchers had 78 disabled list stints due to hamstring injuries over 10 seasons. The landing leg was injured in 67.9% of cases, and the most common mechanism of injury was pitching. There were no significant differences in demographics between pitchers who sustained drive leg and landing leg injuries. There was no significant difference in mechanism of injury or time to return to sport between pitchers who sustained drive leg and landing leg injuries. Conclusion: The landing leg is more commonly injured than the drive leg among MLB pitchers who sustain hamstring injuries. There is no difference in time to return to sport between pitchers who sustain drive leg and landing leg injuries. More research is required to determine whether there is a difference in performance or future injury between hamstring tendons harvested from the drive leg and the landing leg for ulnar collateral ligament reconstruction among pitchers.

Timing of Return to Batting Milestones After Ulnar Collateral Ligament Reconstruction in Professional Baseball Players

2020 ◽  
Vol 48 (6) ◽  
pp. 1465-1470
Author(s):  
Brandon J. Erickson ◽  
Peter N. Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Scott Sheridan ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Professional Baseball ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Common Procedure ◽  
Baseball Players ◽  
Batting Performance ◽  
The Right ◽  
Ulnar Collateral Ligament Reconstruction

Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in professional baseball position players. Timing of return to hitting after UCLR is unknown. Purpose/Hypothesis: The purpose was to determine the time to return to batting milestones after UCLR as well as the effect of UCLR upon batting performance in professional baseball players. The hypothesis was that position players would return to batting in an in-season game before fielding in an in-season game, and hitting performance would remain unchanged after UCLR. Study Design: Cohort study; Level of evidence, 3. Methods: All professional position players who underwent UCLR between 2010 and 2018 were included. Time to batting milestones after UCLR was analyzed. Batting performance before and after UCLR was compared and analyzed. Results: Overall, 141 UCLRs (96% performed on the dominant arm) in 137 position players were included (86% Minor League players). Four players underwent revision, all within 1 year of the primary UCLR. With regard to position, catchers and shortstops were overrepresented. With regard to batting side, 57% batted from the right and 12% batted as switch-hitters. Of the surgeries, 76% were on the trail/back arm. While 91% of players returned to some form of throwing, there was a progressive gradual decline as the rehabilitation process progressed, as only 77% were able to return to hitting in a real game and 75% were able to return to fielding in a real game. The first dry swing occurred at 150 ± 49 days after surgery, the first batting practice occurred at 195 ± 58 days after surgery, the first hitting in a real game occurred at 323 ± 92 days after surgery, and the first fielding in a real game occurred at 343 ± 98 days after surgery. However, players generally saw a decrease in their utilization, with fewer at bats ( P < .001) translating into fewer hits ( P < .001) and runs ( P < .001). Conclusion: Professional position players begin swinging at 150 days (approximately 5 months) after UCLR, while they do not hit in batting practice until 195 days (approximately 6.5 months) and do not hit in a real game until 323 days (approximately 10.7 months) after UCLR. Players see a decrease in hitting utilization after UCLR. On average, players hit in a real game 20 days before fielding in a real game.

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