This study evaluated treatment modality (surgical vs nonoperative) of medial ulnar collateral ligament (UCL) injuries in nonprofessional throwing baseball athletes by comparing type, severity, and location of UCL injury.
Hypothesis:
Baseball players with closed medial epicondyle physes and concomitant throwing-related UCL injury will be more likely to undergo surgical intervention than players with open medial epicondyle physes.
Study Design:
Retrospective.
Level of Evidence:
Level 5.
Methods:
A total of 119 baseball players with a mean age of 16.9 ± 2.5 years (range, 11-25 years) were included in the study. Datapoints included sex, age at time of injury, severity, and location of UCL injury, growth plate status, operative versus conservative management, and concomitant flexor forearm injury.
Results:
A total of 75 players were treated conservatively; 43 underwent UCL reconstruction (UCL-R), and 1 had an unknown treatment outcome. No significant difference was found for age related to treatment type, UCL-R (17.2 ± 2.2) versus conservative treatment (16.8 ± 2.6). Athletes with closed medial epicondylar growth plates were more likely to undergo UCL-R than athletes with open medial epicondylar growth plates (P = 0.02). There were no significant differences between UCL injury location (42 distal, 37 proximal, 18 combined tear locations, 11 complete tears, and 11 intact UCLs with inflammation) by treatment type (P = 0.09). There was a significant difference for UCL severity (11 complete tears, 96 partial tears) by treatment type (P = 0.03).
Conclusion:
Nonprofessional athletes with closed medial epicondylar growth plates and throwing-related UCL injuries were more likely to be treated surgically. Baseball athletes with partial tears, if skeletally immature, require further long-term evaluation.
Clinical Relevance:
Continued knowledge gains in this area of throwing medicine will further improve our treatment algorithms in nonprofessional baseball players.
AgrestaCEKriegKFreehillMT.Risk factors for baseball-related arm injuries: a systematic review. Orthop J Sports Med. 2019;7(2):2325967119825557.
2.
AguinaldoAEscamillaR.Segmental power analysis of sequential body motion and elbow valgus loading during baseball pitching: comparison between professional and high school baseball players. Orthop J Sports Med. 2019;7(2):2325967119827924.
3.
AguinaldoALEscamillaRF.Induced power analysis of sequential body motion and elbow valgus load during baseball pitching. Sports Biomech. 2022;21(7):824-836.
4.
BuckleyPSMorrisERRobbinsCM, et al. Variations in blood supply from proximal to distal in the ulnar collateral ligament of the elbow: a qualitative descriptive cadaveric study. Am J Sports Med. 2019;47(5):1117-1123.
5.
CampCLConteSD’AngeloJFealySA.Epidemiology of ulnar collateral ligament reconstruction in Major and Minor League Baseball pitchers: comprehensive report of 1429 cases. J Shoulder Elbow Surg. 2018;27(5):871-878.
6.
CampCLConteSD’AngeloJFealySAAhmadCS.Effect of predraft ulnar collateral ligament reconstruction on future performance in professional baseball: a matched cohort comparison. Am J Sports Med. 2018;46(6):1459-1464.
7.
CampCLDesaiVConteS, et al. Revision ulnar collateral ligament reconstruction in professional baseball: current trends, surgical techniques, and outcomes. Orthop J Sports Med. 2019;7(8):2325967119864104.
8.
ConteSAFleisigGSDinesJS, et al. Prevalence of ulnar collateral ligament surgery in professional baseball players. Am J Sports Med. 2015;43(7):1764-1769.
9.
DavisJTLimpisvastiOFluhmeD, et al. The effect of pitching biomechanics on the upper extremity in youth and adolescent baseball pitchers. Am J Sports Med. 2009;37(8):1484-1491.
10.
DugasJRLoozeCACapognaB, et al. Ulnar collateral ligament repair with collagen-dipped fibertape augmentation in overhead-throwing athletes. Am J Sports Med. 2019;47(5):1096-1102.
11.
DugasJRWaltersBLBeasonDPFleisigGSChronisterJE.Biomechanical comparison of ulnar collateral ligament repair with internal bracing versus modified Jobe reconstruction. Am J Sports Med. 2016;44(3):735-741.
12.
EricksonBJBachBRJrCohenMS, et al. Ulnar collateral ligament reconstruction: the Rush experience. Orthop J Sports Med. 2016;4(1):2325967115626876.
13.
EricksonBJHarrisJDTetreaultMBush-JosephCCohenMRomeoAA.Is Tommy John surgery performed more frequently in Major League Baseball pitchers from warm weather areas?Orthop J Sports Med. 2014;2(10):2325967114553916.
14.
EricksonBJNwachukwuBURosasS, et al. Trends in medial ulnar collateral ligament reconstruction in the United States: a retrospective review of a large private-payer database from 2007 to 2011. Am J Sports Med. 2015;43(7):1770-1774.
15.
FleisigGSDiffendafferAZIveyB, et al. Changes in youth baseball pitching biomechanics: a 7-year longitudinal study. Am J Sports Med. 2018;46(1):44-51.
16.
FordGMGenuarioJKinkartzJGithensTNoonanT.Return-to-play outcomes in professional baseball players after medial ulnar collateral ligament injuries: comparison of operative versus nonoperative treatment based on magnetic resonance imaging findings. Am J Sports Med. 2016;44(3):723-728.
17.
FrangiamoreSJLynchTSVaughnMD, et al. Magnetic resonance imaging predictors of failure in the nonoperative management of ulnar collateral ligament injuries in professional baseball pitchers. Am J Sports Med. 2017;45(8):1783-1789.
18.
GregoryBNylandJ.Medial elbow injury in young throwing athletes. Muscles Ligaments Tendons J. 2013;3(2):91-100.
19.
GriffithTBAhmadCSGorroochurnP, et al. Comparison of outcomes based on graft type and tunnel configuration for primary ulnar collateral ligament reconstruction in professional baseball pitchers. Am J Sports Med. 2019;47(5):1103-1110.
20.
HodginsJLVitaleMAronsRRAhmadCS.Epidemiology of medial ulnar collateral ligament reconstruction: a 10-year study in New York State. Am J Sports Med. 2016;44(3):729-734.
21.
IkezuMKudoSEdamaM, et al. Sites of flexor-pronator muscle injury and relationship between ulnar collateral ligament injury and flexor-pronator muscle injury in baseball players: a retrospective cohort study. J Shoulder Elbow Surg. 2022;31(8):1588-1594.
22.
JackRAIIBurnMBSochackiKRMcCullochPCLintnerDMHarrisJD.Performance and return to sport after Tommy John surgery among Major League Baseball position players. Am J Sports Med. 2018;46(7):1720-1726.
23.
JackRAIIRaoSD’AmoreT, et al. Long-term sports participation and satisfaction after UCL reconstruction in amateur baseball players. Orthop J Sports Med. 2021;9(8):23259671211027551.
24.
KellerRAMarshallNEGuestJMOkorohaKRJungEKMoutzourosV.Major League Baseball pitch velocity and pitch type associated with risk of ulnar collateral ligament injury. J Shoulder Elbow Surg. 2016;25(4):671-675.
25.
LelandDPConteSFlynnN, et al. Prevalence of medial ulnar collateral ligament surgery in 6135 current professional baseball players: a 2018 update. Orthop J Sports Med. 2019;7(9):2325967119871442.
26.
MarshallNEKellerRALynchJRBeyMJMoutzourosV.Pitching performance and longevity after revision ulnar collateral ligament reconstruction in Major League Baseball pitchers. Am J Sports Med. 2015;43(5):1051-1056.
27.
MirzayanRCooperJD.Chronic medial epicondyle avulsion: technique of fragment excision and ligament reconstruction with internal brace augmentation. J Am Acad Orthop Surg. 2019;27(2):e64-e69.
28.
NodaIKudoS.Relationship between pain, elbow valgus instability, and the function of flexor pronator muscles in baseball players. JSES Int. 2021;5(1):31-34.
29.
NortonRHonstadCJoshiRSilvisMChinchilliVDhawanA.Risk factors for elbow and shoulder injuries in adolescent baseball players: a systematic review. Am J Sports Med. 2019;47(4):982-990.
30.
OsbahrDCCainELJrRainesBTFortenbaughDDugasJRAndrewsJR. Long-term outcomes after ulnar collateral ligament reconstruction in competitive baseball players: minimum 10-year follow-up. Am J Sports Med. 2014;42(6):1333-1342.
31.
OsbahrDCChalmersPNFrankJSWilliamsRJIIIWidmannRFGreenDW.Acute, avulsion fractures of the medial epicondyle while throwing in youth baseball players: a variant of Little League elbow. J Shoulder Elbow Surg. 2010;19(7):951-957.
32.
PalettaGAJrMilnerJ.Repair and internal brace augmentation of the medial ulnar collateral ligament. Clin Sports Med. 2020;39(3):537-548.
33.
RamkumarPNHaeberleHSNavarroSMFrangiamoreSJFarrowLDSchickendantzMS.Clinical utility of an MRI-based classification system for operative versus nonoperative management of ulnar collateral ligament tears: a 2-year follow-up study. Orthop J Sports Med. 2019;7(4):2325967119839785.
34.
SaperMShungJPearceSBompadreVAndrewsJR. Outcomes and return to sport after ulnar collateral ligament reconstruction in adolescent baseball players. Orthop J Sports Med. 2018;6(4):2325967118769328.
35.
TajikaTOyaNIchinoseT, et al. Flexor pronator muscles’ contribution to elbow joint valgus stability: ultrasonographic analysis in high school pitchers with and without symptoms. JSES Int. 2020;4(1):9-14.
36.
WymoreLChinPGearyC, et al. Performance and injury characteristics of pitchers entering the Major League Baseball draft after ulnar collateral ligament reconstruction. Am J Sports Med. 2016;44(12):3165-3170.
ZaremskiJLPazikMDeanCW, et al. Forearm flexor injury is associated with medial ulnar collateral ligament injury in throwing athletes. PM R. Published online March 20, 2021.
