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Oeding JF, Jurgensmeier K, Boos AM, Krych AJ, Okoroha KR, Moatshe G, Camp CL. Early Surgery for Partial Tears of the Ulnar Collateral Ligament May Be More Cost-Effective and Result in Longer Playing Careers Than Nonoperative Management for High-Level Baseball Pitchers: A Decision-Analytic Markov Model-Based Analysis. Am J Sports Med 2024; 52:2319-2330. [PMID: 38899340 DOI: 10.1177/03635465241255147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Nonoperative management versus early reconstruction for partial tears of the medial ulnar collateral ligament (MUCL) remains controversial, with the most common treatment options for partial tears consisting of rest, rehabilitation, platelet-rich plasma (PRP), and/or surgical intervention. However, whether the improved outcomes reported for treatments such as MUCL reconstruction (UCLR) or nonoperative management with a series of PRP injections justifies their increased upfront costs remains unknown. PURPOSE To compare the cost-effectiveness of an initial trial of physical therapy alone, an initial trial of physical therapy plus a series of PRP injections, and early UCLR to determine the preferred cost-effective treatment strategy for young, high-level baseball pitchers with partial tears of the MUCL and with aspirations to continue play at the next level (ie, collegiate and/or professional). STUDY DESIGN Economic and decision analysis; Level of evidence, 2. METHODS A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 young, high-level, simulated pitchers undergoing nonoperative management with and without PRP versus early UCLR for partial MUCL tears. Utility values, return to play rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing each treatment strategy at the authors' institution. Outcome measures included costs, acquired playing years (PYs), and the incremental cost-effectiveness ratio (ICER). RESULTS The mean total costs resulting from nonoperative management without PRP, nonoperative management with PRP, and early UCLR were $22,520, $24,800, and $43,992, respectively. On average, early UCLR produced an additional 4.0 PYs over the 10-year time horizon relative to nonoperative management, resulting in an ICER of $5395/PY, which falls well below the $50,000 willingness-to-pay threshold. Overall, early UCLR was determined to be the preferred cost-effective strategy in 77.5% of pitchers included in the microsimulation model, with nonoperative management with PRP determined to be the preferred strategy in 15% of pitchers and nonoperative management alone in 7.5% of pitchers. CONCLUSION Despite increased upfront costs, UCLR is a more cost-effective treatment option for partial tears of the MUCL than an initial trial of nonoperative management for most high-level baseball pitchers.
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Affiliation(s)
- Jacob F Oeding
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kevin Jurgensmeier
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander M Boos
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gilbert Moatshe
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Hones KM, Kamarajugadda S, Buchanan TR, Portnoff B, Hao KA, Kim J, Wright JO, King JJ, Wright TW, Schoch BS, Aibinder WR. Variable Return to Play and Sport Performance After Elbow Ulnar Collateral Ligament Reconstruction in Baseball Players: A Systematic Review. Arthroscopy 2024; 40:1997-2006.e1. [PMID: 38340970 DOI: 10.1016/j.arthro.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To evaluate return to play (RTP) and return to same level of play (RTSP) rates as well as preoperative and postoperative in-game performance metrics in baseball pitchers who underwent ulnar collateral ligament reconstruction (UCLR). Secondarily, this review sought to assess outcomes based on primary versus revision UCLR as well as level of competition. METHODS This review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane Database of Systematic Reviews were queried to identify articles evaluating UCLR in baseball players between January 2002 and October 2022. Data included RTP, RTSP, and performance metrics including earned run average, innings pitched, walks and hits per inning pitched, batting average against, strikeouts per 9 innings, walks per 9 innings, percentage of fastballs thrown, and average fastball velocity. The Methodological Index for Non-randomized Studies criteria were used for quality assessment. RESULTS Analysis included 25 articles reporting on 2,100 elbows. After primary UCLR, RTP ranged from 336 to 615 days (57% to 100% achieved) and RTSP ranged from 330 to 513 days (61% to 95%). After revision UCLR, RTP ranged from 381 to 631 days (67% to 98%) and RTSP ranged from 518 to 575 days (42% to 78%). When stratifying primary UCLR outcomes by competitive level, RTP and RTSP ranged respectively from 417 to 615 days (75% to 100%) and 513 days (73% to 87%) for Major League Baseball only, 409 to 615 days (57% to 100%) and 470 to 513 days (61% to 95%) for Major League Baseball plus Minor League Baseball, and 336 to 516 days (73% to 85%) and 330 days (55% to 74%) for college plus high school. Heterogeneity was seen in postoperative sports performance metrics. CONCLUSIONS Although more than half of baseball players appear able to RTP after primary and revision UCLR, RTSP rates after revision UCLR were as low as 42% in the literature. Preoperative and postoperative performance metrics varied. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
| | | | | | - Brandon Portnoff
- Department of Orthopedic Surgery, Brown University, Providence, Rhode Island, U.S.A
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Jongmin Kim
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - William R Aibinder
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A..
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Furushima K, Takahashi T, Funakoshi T, Itoh Y. Twisting technique for ulnar collateral ligament reconstruction of the elbow: new possibilities toward enhancing the strength of autografts. JSES Int 2024; 8:614-619. [PMID: 38707581 PMCID: PMC11064566 DOI: 10.1016/j.jseint.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Although the ulnar collateral ligament reconstruction procedure has been increasing in popularity annually owing to its stable postoperative outcomes, the number of revision surgeries following ulnar collateral ligament reconstruction has increased. The success of the initial reconstruction surgery and further improvement in the return-to-play rates of the initial surgery are crucial. In this study, we report on ulnar collateral ligament reconstruction using the twisting technique, which aims to enhance the strength of the graft (palmaris longus tendon) to improve return-to-play rates. Methods We investigated the return-to-play rate and period in 60 cases (2016-2021) that underwent ulnar collateral ligament reconstruction using the twisting technique and 211 cases (2007-2019) that did not use the twisting technique. The twisting technique involved inserting the graft through the bone tunnel and then twisting the doubled tendon. Results According to the Conway-Jobe scale, the twisting technique group had 98.3% excellent, 1.7% good, 0% fair, and 0% poor results, with a mean return-to-play period of 9.8 months. The non-twisting technique group had 86.7% excellent, 9.0% good, 1.9% fair, and 2.4% poor results, with a mean return-to-play period of 11.4 months. The two groups showed significant differences in return-to-play rate (P = .020) and period (P = .022). Conclusion The clinical results of the twisting technique showed that the return-to-play rate of the twisting technique group was higher after than before the procedure, and the return-to-play period was shortened by more than 1 month. The twisting technique may improve the results of ulnar collateral ligament reconstruction surgery.
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Affiliation(s)
- Kozo Furushima
- Sports Medical center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Toru Takahashi
- Sports Medical center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Tadanao Funakoshi
- Sports Medical center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Yoshiyasu Itoh
- Sports Medical center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
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Hones KM, Simcox T, Hao KA, Portnoff B, Buchanan TR, Kamarajugadda S, Kim J, Wright JO, King JJ, Wright TW, Schoch BS, Aibinder WR. Graft choice and techniques used in elbow ulnar collateral ligament reconstruction over the last 20 years: a systematic review and meta-analysis. J Shoulder Elbow Surg 2024; 33:1185-1199. [PMID: 38072032 DOI: 10.1016/j.jse.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Elbow medial ulnar collateral ligament (mUCL) injuries have become increasingly common, leading to a higher number of mUCL reconstructions (UCLR). Various techniques and graft choices have been reported. The purpose of this study was to evaluate the prevalence of each available graft choice, the surgical techniques most utilized, and the reported complications associated with each surgical method. METHODS A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysesguidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify all articles that included UCLR between January 2002 and October 2022. We included all studies that referenced UCLR graft choice, surgical technique, and/or ulnar nerve transposition. Studies were evaluated in a narrative fashion to assess demographics and report current trends in utilization and complications of UCLR as they pertain to graft choice and surgical techniques over the past 20 years. Where possible, we stratified based on graft and technique. RESULTS Forty-seven articles were included, reporting on 6671 elbows. The cohort was 98% male, had a weighted mean age of 21 years and follow-up of 53 months. There were 6146 UCLRs (92%) performed with an autograft and 152 (2.3%) that utilized an allograft, while 373 (5.6%) were from mixed cohorts of autograft and allograft. Palmaris longus autograft was the most utilized mUCL graft choice (64%). The most utilized surgical configuration was the figure-of-8 (68%). Specifically, the most common techniques were the modified Jobe technique (37%), followed by American Sports Medicine Institute (ASMI) (22%), and the docking (22%) technique. A concomitant ulnar nerve transposition was performed in 44% of all patients, with 1.9% of these patients experiencing persistent ulnar nerve symptoms after ulnar nerve transposition. Of the total cohort, 14% experienced postoperative ulnar neuritis with no prior preoperative ulnar nerve symptoms. Further, meta-analysis revealed a significantly greater revision rate with the use of allografts compared to autograft and mixed cohorts (2.6% vs. 1.8% and 1.9%, P = .003). CONCLUSIONS Most surgeons performed UCLR with palmaris autograft utilizing a figure-of-8 graft configuration, specifically with the modified Jobe technique. The overall rate of allograft use was 2.3%, much lower than expected. The revision rate for UCLR with allograft appears to be greater compared to UCLR with autograft, although this may be secondary to limited allograft literature.
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Affiliation(s)
- Keegan M Hones
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Trevor Simcox
- Department of Orthopaedic Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Brandon Portnoff
- Department of Orthopedic Surgery, Brown University, Providence, RI, USA
| | | | | | - Jongmin Kim
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - William R Aibinder
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
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Kunze KN, Fury MS, Pareek A, Camp CL, Altchek DW, Dines JS. Biomechanical Characteristics of Ulnar Collateral Ligament Injuries Treated With and Without Augmentation: A Network Meta-analysis of Controlled Laboratory Studies. Am J Sports Med 2024; 52:1624-1634. [PMID: 38304942 DOI: 10.1177/03635465231188691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Treatment of ulnar collateral ligament (UCL) tears with suture tape augmentation has gained interest given preliminary reports of favorable biomechanical characteristics. No study to date has quantitatively assessed the biomechanical effects of multiple augmentation techniques relative to the native UCL. PURPOSE To perform a systematic review and meta-analysis of controlled laboratory studies to assess and comparatively rank biomechanical effects of UCL repair or reconstruction with or without augmentation. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed, OVID/Medline, and Cochrane databases were queried in January 2023. A frequentist network meta-analytic approach was used to perform mixed-treatment comparisons of UCL repair and reconstruction techniques with and without augmentation, with the native UCL as the reference condition. Pooled treatment estimates were quantified under the random-effects assumption. Competing treatments were ranked in the network meta-analysis by using point estimates and standard errors to calculate P scores (greater P score indicates superiority of treatment for given outcome). RESULTS Ten studies involving 206 elbow specimens in which a distal UCL tear was simulated were included. UCL reconstruction with suture tape augmentation (AugRecon) restored load to failure to a statistically noninferior magnitude (mean difference [MD], -1.99 N·m; 95% CI, -10.2 to 6.2 N·m; P = .63) compared with the native UCL. UCL reconstruction (Recon) (MD, -12.7 N·m; P < .001) and UCL repair with suture tape augmentation (AugRepair) (MD, -14.8 N·m; P < .001) were both statistically inferior to the native UCL. The AugRecon condition conferred greater load to failure compared with Recon (P < .001) and AugRepair (P = .002) conditions. AugRecon conferred greater torsional stiffness relative to all other conditions and was not statistically different from the native UCL (MD, 0.32 N·m/deg; 95% CI, -0.30 to 0.95 N·m/deg; P = .31). Medial ulnohumeral gapping was not statistically different for the AugRepair (MD, 0.30 mm; 95% CI, -1.22 to 1.82 mm; P = .70), AugRecon (MD, 0.57 mm; 95% CI, -0.70 to 1.84 mm; P = .38), or Recon (MD, 1.02 mm; 95% CI, -0.02 to 2.05 mm; P = .055) conditions compared with the native UCL. P-score analysis indicated that AugRecon was the most effective treatment for increasing ultimate load to failure and torsional stiffness, whereas AugRepair was the most effective for minimizing medial gapping. CONCLUSION AugRecon restored load to failure and torsional stiffness most similar to the parameters of the native UCL, whereas Recon and AugRepair did not restore the same advantageous properties at time zero. Medial ulnohumeral gapping during a valgus load was minimized by all 3 treatments. Based on network interactions, AugRecon was the superior treatment approach for restoring important biomechanical features of the UCL at time zero that are jeopardized during a complete distal tear.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, New York, USA
| | - Matthew S Fury
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, New York, USA
| | - Ayoosh Pareek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, New York, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David W Altchek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, New York, USA
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6
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Loushin SR, Verhoeven M, Christoffer DJ, Camp CL, Kaufman KR. Are 4D Motion Sensors Valid and Reliable for Studying Baseball Pitching? Am J Sports Med 2023; 51:1608-1614. [PMID: 37067847 DOI: 10.1177/03635465231166423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Baseball pitching injuries are on the rise. Inertial measurement units (IMUs) provide immediate feedback to players and coaches, allowing for collection outside of the traditional laboratory setting with real-world application. The 4D Motion system provides kinematics throughout the pitching motion and may be beneficial for individualized programs in the throwing athlete. A systematic analysis of these sensors has not been completed. PURPOSE To evaluate the validity of the 4D Motion IMU system for analyzing the baseball pitching motion compared with marker-based motion capture, and evaluate the internal reliability and consistency of the device. STUDY DESIGN Controlled laboratory study. METHODS Ten high school pitchers participated in this study (10 male; 9 right-hand dominant; mean age, 16.6 ± 1.3 years; mean body mass index, 24.1 ± 3.9). Participants were simultaneously outfitted with six 4D Motion IMU sensors and retroreflective markers. The pitchers threw fastballs at maximum effort off a mound at the standard height and distance. A comparison was made between the IMUs and corresponding motion capture values for shoulder external rotation, elbow flexion, chest extension, pelvis and chest rotation velocity, and rotation acceleration. RESULTS Significant differences were found for 5 of 7 metrics analyzed. The IMU overreported most metrics, except for elbow flexion and pelvis rotation angular acceleration, where both positive and negative errors were observed. The root mean square error and percentage errors indicated smaller discrepancies for chest extension (4°± 5°) and pelvis (38 ± 19 deg/s) and chest (96 ± 42 deg/s) rotation velocity, with elbow flexion having the largest variance (21°± 9°). CONCLUSION The values of the 4D Motion IMU system should not be considered equivalent when compared with marker-based motion capture studies. The system lacked internal consistency and reliability, with angular velocities being the most consistent. Caution should be used when using the metrics provided by an IMU-based system for individualized monitoring. CLINICAL RELEVANCE If found valid and reliable, IMUs could be used for longitudinal workload monitoring, individualized throwing and rehabilitation programs, and ultimately injury prevention. This study demonstrates that the data obtained from a 4D Motion system using Gen 3 sensors are not equivalent to the data obtained from a marker-based motion capture system.
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Affiliation(s)
- Stacy R Loushin
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenton R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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LaPrade CM, Cinque ME, Chona DV, Sciascia AD, Abrams GD, Sherman SL, Safran MR, Freehill MT. Revision ulnar collateral ligament reconstruction in Major League Baseball pitchers: effects of fastball velocity and usage. J Shoulder Elbow Surg 2022; 31:1563-1570. [PMID: 35351655 DOI: 10.1016/j.jse.2022.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/20/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) tears are prevalent in Major League Baseball (MLB) pitchers and can cause significant loss of time with varying reports of impact on performance. Revision UCL reconstruction (UCLR) is becoming increasingly common, with little known about the effects on fastball (FB) velocity and usage (FB%) in this setting. HYPOTHESIS/PURPOSE The purpose was to evaluate the effect of revision UCLR on MLB pitchers with respect to postoperative FB velocity and FB% at 1 and 2 years after return to play. The hypothesis was postoperative FB velocity and FB% would significantly decrease vs. prerevision levels, and that revision UCLRs would result in significantly decreased FB velocity and FB% in comparison to a matched group of MLB pitchers after primary UCLR. METHODS Twenty-one pitchers who underwent revision UCLR and returned to MLB play were identified from public records from 2008-2021. The PITCHf(x) system collected FB velocity for 4-seam (4FB) and 2-seam (2FB) fastballs and total FB% for pitchers in the prerevision year as well as the 2 years after return. A matched control group of pitchers who underwent primary UCLR was used for comparison. RESULTS There were no significant differences in FB velocity between prerevision levels (4FB 92.9 mph, 2FB 91.4 mph) and years 1 (4FB 92.5 mph, 2FB 91.2 mph) and 2 (4FB 93.4 mph, 2FB 91.1 mph) after revision UCLR. FB% decreased from the prerevision season (60.1) and the first (56.2, P = .036) and second years (52.5, P = .002) after return. There were no significant differences between FB velocity and FB% or between the revision and primary UCLR groups. CONCLUSION Pitchers returning to the MLB level after revision UCLR can expect similar FB velocity to their prerevision FB velocity and to pitchers undergoing primary UCLR; however, they do demonstrate a decrease in FB%, which may suggest less confidence in their FB after RTP.
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Affiliation(s)
- Christopher M LaPrade
- Departments of Orthopaedic Surgery and Sports Medicine, Stanford University, Redwood City, CA, USA
| | - Mark E Cinque
- Departments of Orthopaedic Surgery and Sports Medicine, Stanford University, Redwood City, CA, USA
| | - Deepak V Chona
- Departments of Orthopaedic Surgery and Sports Medicine, Stanford University, Redwood City, CA, USA
| | - Aaron D Sciascia
- Department of Exercise and Sport Science, Eastern Kentucky University, Richmond, KY, USA
| | - Geoffrey D Abrams
- Departments of Orthopaedic Surgery and Sports Medicine, Stanford University, Redwood City, CA, USA
| | - Seth L Sherman
- Departments of Orthopaedic Surgery and Sports Medicine, Stanford University, Redwood City, CA, USA
| | - Marc R Safran
- Departments of Orthopaedic Surgery and Sports Medicine, Stanford University, Redwood City, CA, USA
| | - Michael T Freehill
- Departments of Orthopaedic Surgery and Sports Medicine, Stanford University, Redwood City, CA, USA.
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LaPrade CM, Cinque ME, Safran MR, Freehill MT, Wulf CA, LaPrade RF. Using Advanced Data to Analyze the Impact of Injury on Performance of Major League Baseball Pitchers: A Narrative Review. Orthop J Sports Med 2022; 10:23259671221111169. [PMID: 35898207 PMCID: PMC9310227 DOI: 10.1177/23259671221111169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 12/05/2022] Open
Abstract
Major league baseball (MLB) pitchers are at risk of numerous injuries during
play, and there is an increasing focus on evaluating their performance in the
context of injury. Historically, performance after return to play (RTP) from
injury has focused on general descriptive statistics, such as innings or games
played, or rate statistics with inherent variability (eg, earned run average,
walks and hits per inning pitched, strikeouts per 9 innings, or walks per 9
innings). However, in recent years, MLB has incorporated advanced technology and
tracking systems in every stadium, allowing for more in-depth analysis of
pitcher-specific data that are captured with every pitch of every game. This
technology allows for the ability to delve into the pitching performance on a
basis that is more specific to each pitcher and allows for more in-depth
analysis of different aspects of pitching performance. The purpose of this
narrative review was to illustrate the current state of injury recording for
professional baseball pitchers, highlight recent technological advances in MLB,
and describe the advanced data available for analysis. We used advanced data in
the literature to review the current state of performance analysis after RTP in
MLB pitchers after injury. Finally, we strived to provide a framework for future
studies to more meticulously assess RTP performance given the current available
resources for analysis.
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Affiliation(s)
- Christopher M LaPrade
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Mark E Cinque
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
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Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:2324-2338. [PMID: 34491153 DOI: 10.1177/03635465211023952] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The most commonly used techniques for elbow ulnar collateral ligament reconstruction (UCLR) are the docking and modified Jobe figure-of-8 techniques. Previous literature has suggested that UCLR with the docking technique is associated with fewer complications; however, these studies included results from the original classic Jobe technique without controlling for the effects of flexor pronator mass (FPM) detachment and routine submuscular ulnar nerve transposition (UNT). PURPOSE/HYPOTHESIS This study sought to compare the rates of complications and subsequent unplanned surgical procedures between the docking and figure-of-8 techniques. We hypothesized that there would be no significant difference in the rates of complications or subsequent unplanned surgical procedures between the techniques when the FPM was preserved and no routine submuscular UNT was performed. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A series of mixed-effects multivariate metaregression models were implemented using the restricted maximum likelihood method. Complications and subsequent unplanned surgical procedures were modeled as Freeman-Tukey transformed incidence rates for variance stabilization, and nerve-specific complications were assessed as the Freeman-Tukey transformed proportion of cases, with back-transformation to estimate summary effects. RESULTS There were 19 studies eligible for qualitative analysis, consisting of 1788 cases of UCLR (303 docking, 1485 figure-of-8), 18 of which were suitable for quantitative analysis (1769 cases; 291 docking, 1478 figure-of-8). A total of 338 complications were reported (17 for docking, 321 for figure-of-8), the majority of which were nerve related. Additionally, a total of 75 subsequent unplanned surgical procedures were related to the index UCLR procedure. There was no significant difference in the rate of complications (P = .146) or proportion of cases with nerve-specific complications (P = .127) between the docking and figure-of-8 techniques when controlling for FPM preservation versus detachment with submuscular UNT. FPM detachment with submuscular UNT was independently associated with a significantly higher proportion of postoperative nerve-related complications (P = .004). There was also no significant difference in the rates of subsequent unplanned surgical procedures between the docking and figure-of-8 techniques (P = .961), although FPM detachment with routine submuscular UNT was independently associated with a significantly higher incidence of subsequent unplanned surgical procedures. CONCLUSION The results of this study demonstrate no significant difference in the rates of complications or subsequent unplanned surgical procedures between the figure-of-8 and docking techniques for UCLR when controlling for FPM preservation versus detachment with submuscular UNT. With modern muscle-sparing approaches and avoiding submuscular UNT, the modified Jobe technique does not differ significantly from the docking technique in terms of complication rates, proportions of cases with nerve-specific complications, or rates of subsequent unplanned surgical procedures.
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Affiliation(s)
- Austin M Looney
- Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC, USA.,The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Mark A Pianka
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Caroline M Fryar
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Christine M Conroy
- Department of Orthopedics, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Jacob E Israel
- Georgetown University School of Medicine, Washington, DC, USA
| | - David X Wang
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Michael G Ciccotti
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edward S Chang
- Department of Orthopedics, Inova Fairfax Hospital, Falls Church, Virginia, USA
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10
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Griffith TB, Conte S, Poulis GC, Diamond A, D'Angelo J, Camp CL. Correlation of Rehabilitation and Throwing Program Milestones With Outcomes After Ulnar Collateral Ligament Reconstruction: An Analysis of 717 Professional Baseball Pitchers. Am J Sports Med 2022; 50:1990-1996. [PMID: 35532953 DOI: 10.1177/03635465221093995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There remains room for improvement in surgical outcomes after medial ulnar collateral ligament reconstruction (MUCLR) in professional pitchers. The role and influence of postoperative rehabilitation on the outcomes of MUCLR are unknown. There is a paucity of clinical data in the current literature comparing the success of various postsurgical rehabilitation protocols after MUCLR. PURPOSE To summarize the current rehabilitation process for professional pitchers recovering from MUCLR, evaluates what player and surgical factors correlate with outcomes, and determines whether rehabilitation timing and milestones correlate with successful outcomes. STUDY DESIGN Case series; Level of evidence, 4. METHODS 717 professional baseball pitchers who underwent MUCLR between 2010 and 2016 were identified and included in the analysis. Player characteristics evaluated included age at the time of surgery, throwing side dominance, primary pitching role (starter vs reliever), and level of play (MLB, AAA, AA, A). Surgical factors studied included date of surgery, graft type (palmaris longus autograft vs gracilis autograft), and surgical technique (figure of 8 vs docking vs other). The rehabilitation and throwing progression details were as follows: initiation date; first throw date; dates to start throwing from various distances; longest distance thrown; first flat ground throw date; first mound throw date; and first live batting practice (BP) date. The primary outcomes of interest were the ability to return to play at any level (RTP), the ability to return to the same level (RSL), and the time to RTP/RSL. RESULTS On average, pitchers threw a baseball for the first time 4.9 months after surgery, with a broad range (2.8-14.9 months). For the 675 (94%) pitchers who were able to progress to mound throwing, the first throws off a mound occurred at a mean of 9.4 months after surgery. Before progressing to the mound, the mean longest long-toss distance reached was 137.5 feet, with a broad range (105-300 feet). A high variation in the time to RTP (7.6-53.9 months) and RSL (8.6-60.7 months) was noted. A total of 599 (84%) pitchers were able to RTP at a mean time of 14.9 ± 4.9 months after surgery (range, 7.6-53.9 months). Also, 528 (74%) pitchers were able to RSL after MUCLR at a mean of 17.4 ± 7 months (range, 8.6-60.7 months) postoperatively. Age was the most significant predictor of RTP (hazard ratio [HR], 1.03 [95% CI, 1.01-1.05]; P = .01) and RSL (HR, 0.96 [95% CI, 0.93-0.99]; P < .01). For every 1-year increase in age, there was a 3% increase in the chance of RTP. Conversely, for every 1-year decrease in age, there was a 4% increase in the chance of RSL. MLB players were more likely to RTP (HR, 1.39 [95% CI, 1.18-1.63]; P < .01) but not necessarily to RSL (HR, 0.90 [95% CI, 0.75-1.08]; P = .24). The time from surgery to any of the rehabilitation milestones of interest (first throw, first flat ground pitching, first mound throwing, and first live BP) did not correlate with RTP or RSL (all, P >.05). The same was true for the greatest long-toss distance thrown before transitioning to the mound. CONCLUSION Significant variability in the postoperative rehabilitation protocols after MUCLR was observed in 717 professional baseball pitchers. The timing of achievement of throwing progression and rehabilitation milestones postoperatively varied widely but did not correlate with outcomes. Player characteristics-except for player age and professional pitching level-did not correlate with RTP and RSL outcomes. Older pitchers and MLB pitchers were more likely to RTP, but younger players were more likely to RSL. Surgical factors did not correlate with rehabilitation outcomes.
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Affiliation(s)
- Timothy B Griffith
- Peachtree Orthopedics, Department of Sports Medicine and Orthopedic Surgery, Atlanta Braves Baseball Club, Atlanta, Georgia, USA.,Head Athletic Trainer/Director of Player Health, Atlanta Braves Baseball Club, Atlanta, Georgia, USA
| | - Stan Conte
- Conte Sports Performance Therapy, Scottsdale, Arizona, USA
| | - George C Poulis
- Head Athletic Trainer/Director of Player Health, Atlanta Braves Baseball Club, Atlanta, Georgia, USA
| | - Adam Diamond
- Physical Therapist, Minnesota Twins Baseball Club, Minneapolis, Minnesota, USA
| | - John D'Angelo
- Office of the Commissioner, Major League Baseball, New York, New York, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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11
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Steffes MJ, Heaps BM, ElAttrache NS, Haselman WT. Outcomes After Medial Ulnar Collateral Ligament Graft Repair in Professional Baseball Pitchers With Minimum 2-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221092728. [PMID: 35547610 PMCID: PMC9083042 DOI: 10.1177/23259671221092728] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Rerupture of the reconstructed ulnar collateral ligament (UCL) is becoming more frequent at the professional level of baseball. However, there is no literature describing outcomes after UCL graft repair. Purpose To evaluate rerupture rate, return to play, performance upon return, and patient-reported outcomes after a novel UCL graft repair technique. Study Design Case series; Level of evidence, 4. Methods All included patients underwent UCL graft repair after a previous UCL reconstruction, pitched in at least 1 professional baseball game before repair, and were at least 2 years postprocedure within the same 10-year time period. The authors evaluated patient characteristics and performance metrics, including wins, losses, win percentage, earned run average, innings pitched, walks and hits per inning pitched, for the 2 seasons before and after the procedure. Patients were contacted to assess UCL rerupture, timing of return to sport, current level of competition, Conway score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score. Results Six players met the inclusion criteria. All had proximal UCL graft ruptures and underwent flexor-pronator tendon repair in combination with graft repair. At a mean (±SD) follow-up of 56.7 ± 37.8 months, no reruptures were encountered, and the mean KJOC score was 87.9 ± 14.6. Of the 6 pitchers who underwent UCL graft repair, 4 (67%) returned to professional pitching at a mean of 17 ± 6 months. Three of the 6 (50%) achieved an excellent Conway score, signifying a return to prior level of sport. There was no significant difference in demographic or preoperative pitching performance metrics between players who did and did not return to pitching. For those players who returned to professional pitching, there was no significant difference between preprocedure and postprocedure performance statistics. Conclusion Repair of the UCL graft appears to yield comparable rates of return to play and performance with revision UCL reconstruction. This technique serves as a viable alternative for proximal avulsion ruptures of the UCL graft.
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Affiliation(s)
| | - Braiden M. Heaps
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
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12
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Mizels J, Erickson B, Chalmers P. Current State of Data and Analytics Research in Baseball. Curr Rev Musculoskelet Med 2022; 15:283-290. [PMID: 35486325 DOI: 10.1007/s12178-022-09763-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Baseball has become one of the largest data-driven sports. In this review, we highlight the historical context of how big data and sabermetrics began to transform baseball, the current methods for data collection and analysis in baseball, and a look to the future including emerging technologies. RECENT FINDINGS Machine learning (ML), artificial intelligence (AI), and modern motion-analysis techniques have shown promise in predicting player performance and preventing injury. With the advent of the Health Injury Tracking System (HITS), numerous studies have been published which highlight the epidemiology and performance implications for specific injuries. Wearable technologies allow for the prospective collection of kinematic data to improve pitching mechanics and prevent injury. Data and analytics research has transcended baseball over time, and the future of this field remains bright.
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Affiliation(s)
- Joshua Mizels
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | | | - Peter Chalmers
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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13
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Chang ES, Le AH, Looney AM, Colantonio DF, Roach WB, Helgeson MD, Clark DM, Fredericks DR, Nagda SH. Biomechanical Comparison of Anatomic Restoration of the Ulnar Footprint vs Traditional Ulnar Tunnels in Ulnar Collateral Ligament Reconstruction. Am J Sports Med 2022; 50:1375-1381. [PMID: 34889687 DOI: 10.1177/03635465211054475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current techniques for ulnar collateral ligament (UCL) reconstruction do not reproduce the anatomic ulnar footprint of the UCL. The purpose of this study was to describe a novel UCL reconstruction technique that utilizes proximal-to-distal ulnar bone tunnels to better re-create the anatomy of the UCL and to compare the biomechanical profile at time zero among this technique, the native UCL, and the traditional docking technique. HYPOTHESIS The biomechanical profile of the anatomic technique is similar to the native UCL and traditional docking technique. STUDY DESIGN Controlled laboratory study. METHODS Ten matched cadaveric elbows were potted with the forearm in neutral rotation. The palmaris longus tendon graft was harvested, and bones were sectioned 14 cm proximal and distal to the elbow joint. Specimen testing included (1) native UCL testing performed at 90° of flexion with 0.5 N·m of valgus moment preload, (2) cyclic loading from 0.5 to 5 N·m of valgus moment for 1000 cycles at 1 Hz, and (3) load to failure at 0.2 mm/s. Elbows then underwent UCL reconstruction with 1 elbow of each pair receiving the classic docking technique using either anatomic (proximal to distal) or traditional (anterior to posterior) tunnel locations. Specimen testing was then repeated as described. RESULTS There were no differences in maximum load at failure between the anatomic and traditional tunnel location techniques (mean ± SD, 34.90 ± 10.65 vs 37.28 ± 14.26 N·m; P = .644) or when including the native UCL (45.83 ± 17.03 N·m; P = .099). Additionally, there were no differences in valgus angle after 1000 cycles across the anatomic technique (4.58°± 1.47°), traditional technique (4.08°± 1.28°), and native UCL (4.07°± 1.99°). The anatomic group and the native UCL had similar valgus angles at failure (24.13°± 5.86° vs 20.13°± 5.70°; P = .083), while the traditional group had a higher valgus angle at failure when compared with the native UCL (24.88°± 6.18° vs 19.44°± 5.86°; P = .015). CONCLUSION In this cadaveric model, UCL reconstruction with the docking technique utilizing proximal-to-distal ulnar tunnels better restored the ulnar footprint while providing valgus stability comparable with reconstruction with the docking technique using traditional anterior-to-posterior ulnar tunnel locations. These results suggest that utilization of the anatomic tunnel location in UCL reconstruction has similar biomechanical properties to the traditional method at the time of initial fixation (ie, not accounting for healing after reconstruction in vivo) while keeping the ulnar tunnels farther from the ulnar nerve. Further studies are warranted to determine if an anatomically based UCL reconstruction results in differing outcomes than traditional reconstruction techniques. CLINICAL RELEVANCE Current UCL reconstruction techniques do not accurately re-create the ulnar UCL footprint. The UCL is a dynamic constraint to valgus loads at the elbow, and a more anatomic reconstruction may afford more natural joint kinematics. This more anatomic technique performs similarly to the traditional docking technique at time zero, and the results of this study may offer a starting point for future in vivo studies.
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Affiliation(s)
- Edward S Chang
- Department of Orthopedic Surgery, Inova Health System, Fairfax, Virginia, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Anthony H Le
- Extremity Trauma and Amputation Center of Excellence, Walter Reed National Military Medical Center, Department of Defense-Department of Veterans Affairs, Bethesda, Maryland, USA
| | - Austin M Looney
- Department of Orthopedic Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - Donald F Colantonio
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - William B Roach
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Melvin D Helgeson
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - DesRaj M Clark
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Donald R Fredericks
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Sameer H Nagda
- Department of Orthopedic Surgery, Inova Health System, Fairfax, Virginia, USA.,Anderson Orthopaedic Clinic, Arlington, Virginia, USA
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14
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Carr JB, Wilson L, Sullivan SW, Poeran J, Liu J, Memtsoudis SG, Nwachukwu BU. Seasonal and monthly trends in elbow ulnar collateral ligament injuries and surgeries: a national epidemiological study. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:107-112. [PMID: 37588284 PMCID: PMC10426475 DOI: 10.1016/j.xrrt.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Monthly incidence of elbow ulnar collateral ligament (UCL) injuries and surgeries is relatively unknown. Defining seasonal peaks of UCL injuries and surgeries may identify opportunities for injury-prevention strategies. The purpose of this study is to analyze seasonal and monthly variations in UCL injuries and surgeries across the United States with emphasis on the timing of baseball season. Methods The Truven Health MarketScan database (2013-2015) was queried for patients younger than 40 years with a diagnosis code of elbow UCL sprain and a procedural code for UCL repair or reconstruction. Differences in patient characteristics were evaluated using chi-square and Mann-Whitney U-tests. Negative binomial regression models were calculated for UCL injuries and surgeries to assess monthly trends. Results UCL injuries were sustained by 13,894 patients, with 1404 (10.1%) patients having undergone surgery. The median age at first diagnosis was 17 years, and the median age of patients requiring surgery decreased from 20 to 18 years from 2013 to 2015 (P = .75). Most UCL injuries (n = 3785) and surgeries (n = 438) occurred during the spring season (March 21-June 20), and spring injuries were most likely to result in surgical management (11.6%). During the baseball season (March to September), the number of UCL injuries peaked in April/May, then declined, except for a second peak in September/October (incidence rate ratio 0.97; confidence interval 0.95, 0.99; P = .01). The number of UCL surgeries steadily increased from March (n = 116) to June (n = 152), followed by a gradual decline (incidence rate ratio 1.00; confidence interval 0.96, 1.04; P = .99). Conclusion Athletes frequently experienced UCL injuries and surgeries in the early months (April-June) of the baseball season. More emphasis should be paid to rehabilitative strategies at the beginning of a baseball season to help mitigate injury risk.
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Affiliation(s)
- James B. Carr
- Hospital for Special Surgery, Sports Medicine Institute, New York, NY, USA
| | - Lauren Wilson
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | | | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Stavros G. Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
- Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
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15
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Rothermich MA, Fleisig GS, Conte SA, Hart KM, Cain EL, Dugas JR. Short-Term Trends in Elbow Ulnar Collateral Ligament Surgery in Collegiate Baseball Players: An Analysis of 25,587 Player-Years. Orthop J Sports Med 2021; 9:23259671211016846. [PMID: 34377712 PMCID: PMC8330484 DOI: 10.1177/23259671211016846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Trends over time in the incidence of ulnar collateral ligament (UCL) surgeries in National Collegiate Athletic Association Division I baseball players are currently unknown. Purpose/Hypothesis The purpose of this study was to evaluate the trends in UCL surgeries over 3 years in Division I baseball programs. We hypothesized that surgical injuries would be consistently high over the course of the study. Study Design Descriptive epidemiology study. Methods Athletic trainers from Division I baseball programs were invited to participate in an electronic survey over 3 seasons. A total of 155 baseball programs agreed to participate in 2017, 294 programs participated in 2018, and 296 programs participated in 2019. After each of the 3 collegiate baseball seasons, the athletic trainer from each program entered anonymous, detailed descriptive data and surgical information on injured players into a secured database. Results During the 3 years of this study, 100% of the enrolled programs successfully completed the survey (155/155 in year 1, 294/294 in year 2, and 296/296 in year 3). This registry of 745 completed surveys over 3 years represented 25,587 player-years from Division I collegiate baseball. The percentage of programs with at least 1 UCL surgery during this time was 57% in 2017, 51% in 2018, and 49% in 2019. The majority of these players were pitchers (84% overall from the 3 years). Seniors underwent a significantly lower percentage of the UCL surgeries (8% in 2017, 10% in 2018, and 13% in 2019) than did underclassmen. Surgeries were performed most often in-season and least often during the preseason. A slight majority of players undergoing surgery originated from warm-weather states, but the number of these players was never significantly higher than was the number of players from cold-weather states. Most surgeries performed each year were UCL reconstruction, but the percentage of UCL repair with ligament augmentation increased each year (10% UCL repairs in 2017, 20% in 2018, and 25% in 2019). Conclusion UCL injuries requiring surgery were found to be a major source of morbidity in Division I collegiate baseball, supporting our hypothesis. This study can serve as a baseline for tracking long-term trends in UCL surgeries in collegiate baseball.
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Affiliation(s)
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Stan A Conte
- Conte Injury Analytics LLC, Scottsdale, Arizona USA
| | - Karen M Hart
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - E Lyle Cain
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Jeffrey R Dugas
- American Sports Medicine Institute, Birmingham, Alabama, USA
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16
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Biomechanical assessment of docking ulnar collateral ligament reconstruction after failed ulnar collateral ligament repair with suture augmentation. J Shoulder Elbow Surg 2021; 30:1477-1486. [PMID: 33276162 DOI: 10.1016/j.jse.2020.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/24/2020] [Accepted: 10/30/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) repair with single-strand suture augmentation has been introduced as a viable surgical option for throwers with acute UCL tears. For the original single-strand suture augmentation construct, revision UCL reconstructions can be challenging owing to the bone loss at the site of anchor insertion in the center of the sublime tubercle. This biomechanical study assessed a small-diameter (1.5-mm) ulnar bone tunnel technique for double-strand suture-augmented UCL repair that may be more easily converted to salvage UCL reconstruction if necessary, as well as a salvage UCL reconstruction with a docking technique after a failed primary suture-augmented UCL repair. METHODS In 7 fresh-frozen cadaveric upper extremities (mean age, 66.3 years), a custom shoulder testing system was used to simulate the late cocking phase of throwing. The elbow valgus opening angle was evaluated using a MicroScribe 3DLX device for sequentially increasing valgus torque (from 0.75 to 7.5 Nm in 0.75-Nm increments) at 90° of flexion. Valgus angular stiffness (in newton-meters per degree) was defined as the correlation of sequentially increasing valgus torque with the valgus opening angle through simple linear regression (slope of valgus torque - valgus opening angle curve). Four conditions were tested: intact elbow, distal UCL avulsion, primary UCL repair with double-strand suture augmentation using small-diameter bone tunnels, and subsequent docking UCL reconstruction in the same specimen. Load-to-failure tests were performed for primary UCL repair with double-strand suture augmentation and subsequent docking UCL reconstruction. RESULTS With increasing elbow valgus torque, the valgus opening angle increased linearly in each condition (R2 ≥ 0.98, P < .001). Distal UCL avulsion resulted in significantly decreased angular stiffness compared with the intact UCL (P < .001). Both UCL repair with double-strand suture augmentation and subsequent UCL reconstruction showed significantly increased angular stiffness values compared with distal UCL avulsion (P < .001 and P < .001, respectively). On load-to-failure testing, there was no significant difference in stiffness, yield torque, and ultimate torque between the primary suture-augmented UCL repair and the subsequent UCL reconstruction (P = .11, P = .77, and P = .38, respectively). In all specimens undergoing the small-diameter ulnar bone tunnel technique for double-strand suture-augmented UCL repair, failure occurred by retear of the repaired ligament without causing an ulnar bone bridge fracture. CONCLUSION Primary UCL repair with double-strand suture augmentation using small-diameter bone tunnels was able to restore valgus stability. When failure occurs, this technique retains enough cortical bone to permit subsequent docking UCL reconstruction.
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17
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Yu JS, Carr JB, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Orthop J Sports Med 2021; 9:2325967121990052. [PMID: 34250162 PMCID: PMC8239339 DOI: 10.1177/2325967121990052] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Social media posts regarding ulnar collateral ligament (UCL) injuries and
reconstruction surgeries have increased in recent years. Purpose: To analyze posts shared on Instagram and Twitter referencing UCL injuries and
reconstruction surgeries to evaluate public perception and any trends in
perception over the past 3 years. Study Design: Cross-sectional study. Methods: A search of a 3-year period (August 2016 and August 2019) of public Instagram
and Twitter posts was performed. We searched for >22 hashtags and search
terms, including #TommyJohn,
#TommyJohnSurgery, and #tornUCL. A
categorical classification system was used to assess the sentiment, media
format, perspective, timing, accuracy, and general content of each post.
Post popularity was measured by number of likes and comments. Results: A total of 3119 Instagram posts and 267 Twitter posts were included in the
analysis. Of the 3119 Instagram posts analyzed, 34% were from patients, and
28% were from providers. Of the 267 Twitter posts analyzed, 42% were from
patients, and 16% were from providers. Although the majority of social media
posts were of a positive sentiment, over the past 3 years, there was a major
surge in negative sentiment posts (97% increase) versus positive sentiment
posts (9% increase). Patients were more likely to focus their posts on
rehabilitation, return to play, and activities of daily living. Providers
tended to focus their posts on education, rehabilitation, and injury
prevention. Patient posts declined over the past 3 years (–28%), whereas
provider posts increased substantially (110%). Of posts shared by health
care providers, 4% of posts contained inaccurate or misleading
information. Conclusion: The majority of patients who post about their UCL injury and reconstruction
on social media have a positive sentiment when discussing their procedure.
However, negative sentiment posts have increased significantly over the past
3 years. Patient content revolves around rehabilitation and return to play.
Although patient posts have declined over the past 3 years, provider posts
have increased substantially with an emphasis on education.
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Affiliation(s)
- Jonathan S Yu
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - James B Carr
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA.,Hospital for Special Surgery Florida, West Palm Beach, FL, USA
| | - Jacob Thomas
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Julianna Kostas
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Zhaorui Wang
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Tyler Khilnani
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Katie Liu
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Joshua S Dines
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA.,Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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18
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Thomas SJ, Paul RW, Rosen AB, Wilkins SJ, Scheidt J, Kelly JD, Crotin RL. Return-to-Play and Competitive Outcomes After Ulnar Collateral Ligament Reconstruction Among Baseball Players: A Systematic Review. Orthop J Sports Med 2020; 8:2325967120966310. [PMID: 33748295 PMCID: PMC7905078 DOI: 10.1177/2325967120966310] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Stephen J Thomas
- College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Penn Throwing Clinic, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan W Paul
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Adam B Rosen
- School of Health and Kinesiology, University of Nebraska Omaha, Omaha, Nebraska, USA
| | - Sam J Wilkins
- School of Health and Kinesiology, University of Nebraska Omaha, Omaha, Nebraska, USA
| | | | - John D Kelly
- Penn Throwing Clinic, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan L Crotin
- Penn Throwing Clinic, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Los Angeles Angels, Anaheim, California, USA
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19
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Kennon JC, Marigi EM, Songy CE, Bernard C, O’Driscoll SW, Sanchez-Sotelo J, Camp CL. Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years. Orthop J Sports Med 2020; 8:2325967120959141. [PMID: 33134400 PMCID: PMC7576921 DOI: 10.1177/2325967120959141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.
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Affiliation(s)
- Justin C. Kennon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Chad E. Songy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Chris Bernard
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Christopher L. Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Christopher L. Camp, MD, Mayo Clinic, 200 First Street SW, Rochester MN 55905, USA () (Twitter: @ChrisCampMD)
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20
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Andrews JR, Venkateswaran V, Christensen KD, Plummer HA, Hart KM, Opitz TJ, Wilk KE, Pinegar CO, Cain EL, Dugas JR, Jordan SE, Fleisig GS. Outcomes After Ulnar Collateral Ligament Revision Reconstruction in Baseball Players. Am J Sports Med 2020; 48:3359-3364. [PMID: 33085494 DOI: 10.1177/0363546520951529] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a lack of evidence regarding the success of ulnar collateral ligament (UCL) revision reconstruction. Understanding outcomes after UCL revision reconstruction is important in clinical decision making for overhead athletes. PURPOSE To evaluate return to play and patient-reported outcomes after UCL revision reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients who underwent UCL revision reconstruction, attributed to retear of the ligament or pain, between June 2004 and July 2016 at 2 surgical centers were identified. Charts were reviewed for age, sex, date of primary and revision reconstruction, sport played, level of play, graft type, and complications. Patients were contacted by telephone to determine time to return to play, current level of participation, Conway score, Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, and satisfaction. RESULTS Of the 65 consecutive baseball players who underwent revision UCL reconstruction, 40 (62%) were contacted at a minimum 22 months after surgery. Of these, 38 (95%) were pitchers and 2 (5%) were position players. Time to return to throwing was 6.2 ± 2.3 months (mean ± SD), and the KJOC score was 74.2 ± 20.7. Based on the Conway score, 50% (20/40) had an excellent result, indicating a return to the previous competition level for at least 1 year, and 30% (12/40) had a good result, indicating a return to a lower level for at least 1 year. For those who were able to return to competition, it took 12.7 ± 3.6 months. In pitchers, 47% (18/38) returned to their previous competition levels for at least 1 year, with a KJOC score of 73.7 ± 21.1. Pitchers were able to return to throwing at 6.3 ± 2.3 months and competition at 12.8 ± 3.7 months. CONCLUSION Only half of baseball players undergoing UCL revision reconstruction were able to return to their previous levels of competition. Outcomes for revision reconstructions are not as promising as primary procedures. Baseball players should be cautioned that they may not return to their previous levels of play after a revision reconstruction.
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Affiliation(s)
- James R Andrews
- Andrews Research and Education Foundation, Gulf Breeze, Florida, USA.,American Sports Medicine Institute, Birmingham, Alabama, USA.,Andrews Institute for Orthopaedics and Sports Medicine, Gulf Breeze, Florida, USA.,Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Vikram Venkateswaran
- Georgetown Orthopaedic Associates, Halton Healthcare, Georgetown, Ontario, Canada
| | | | - Hillary A Plummer
- Andrews Research and Education Foundation, Gulf Breeze, Florida, USA
| | - Karen M Hart
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Tyler J Opitz
- Andrews Institute for Orthopaedics and Sports Medicine, Gulf Breeze, Florida, USA
| | - Kevin E Wilk
- American Sports Medicine Institute, Birmingham, Alabama, USA.,Champion Sports Medicine, Birmingham, Alabama, USA
| | - Caleb O Pinegar
- Crovetti Orthopaedics and Sports Medicine, Henderson, Nevada, USA
| | - E Lyle Cain
- American Sports Medicine Institute, Birmingham, Alabama, USA.,Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Jeffrey R Dugas
- American Sports Medicine Institute, Birmingham, Alabama, USA.,Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Steve E Jordan
- Andrews Research and Education Foundation, Gulf Breeze, Florida, USA.,Andrews Institute for Orthopaedics and Sports Medicine, Gulf Breeze, Florida, USA
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA
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21
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Lawton CD, Lamplot JD, Wright-Chisem JI, James EW, Camp CL, Dines JS. State of the Union on Ulnar Collateral Ligament Reconstruction in 2020: Indications, Techniques, and Outcomes. Curr Rev Musculoskelet Med 2020; 13:338-348. [PMID: 32323247 PMCID: PMC7251011 DOI: 10.1007/s12178-020-09621-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW There has been a marked increase in the number of ulnar collateral ligament reconstructions performed annually and an associated increase in the amount of recent literature published. It is paramount that surgeons remain up to date on the current literature, as modern indications and surgical techniques continue to improve clinical outcomes. RECENT FINDINGS Our understanding of ulnar collateral ligament (UCL) injuries, treatment indications, and surgical techniques for UCL reconstruction continues to evolve. Despite the rapidly increasing amount of published literature on the topic, a clear and concise surgical algorithm is lacking. Studies have suggested a trend towards improved clinical outcomes and decreased complications with various modifications in UCL reconstruction techniques. Current sport-specific outcome studies have reported conflicting results regarding the effect of UCL reconstruction on an athlete's performance upon returning to sport. With the rising incidence of UCL reconstruction and growing media attention, UCL injuries, reconstruction techniques, and return to sport following UCL surgery are timely topics of interest to clinicians and overhead throwing athletes. Several technique modifications have been reported, and these modifications may lead to improved outcomes and lower complication rates. Studies assessing sport-specific outcome measures will be necessary to provide a more critical and informative analysis of outcomes following UCL reconstruction.
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Affiliation(s)
- Cort D Lawton
- Sports Medicine and Shoulder Service, Sports Medicine Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Joseph D Lamplot
- Sports Medicine and Shoulder Service, Sports Medicine Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Joshua I Wright-Chisem
- Sports Medicine and Shoulder Service, Sports Medicine Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Evan W James
- Sports Medicine and Shoulder Service, Sports Medicine Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Christopher L Camp
- Division of Sports Medicine, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
| | - Joshua S Dines
- Sports Medicine and Shoulder Service, Sports Medicine Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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22
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Keyt LK, Tangtiphaiboontana J, Turner TW, Dines JS, Knudsen ML, Camp CL. Revision Medial Ulnar Collateral Ligament Reconstruction in Baseball Pitchers: Review of Epidemiology, Surgical Techniques, and Outcomes. Curr Rev Musculoskelet Med 2020; 13:361-368. [PMID: 32285301 DOI: 10.1007/s12178-020-09619-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The purposes of this review are to describe the epidemiology, treatment options, and clinical outcomes of revision medial ulnar collateral ligament reconstruction in baseball pitchers. RECENT FINDINGS Rates of revision UCL range from 1 to 15% and have slowly increased over the past several years. Revision UCL procedures are associated with higher complication rates, likely due to the distortion of innate anatomy after primary reconstruction. Techniques for reconstruction are largely influenced by the index surgery and integrity of the ulnar and humeral bone tunnels/sockets. Current literature reporting on the outcomes following revision UCL reconstruction is limited to case series and database studies. Mean time between primary reconstruction and revision surgery is approximately 5 years and return to play rates range from 47 to 85%. Outcomes following revision UCL reconstruction are relatively guarded compared with those of primary UCL reconstruction with the most studies reporting lower return to play rates, decreased workloads compared with pre-injury levels of play, and shorter career longevity following revision surgery. Future research regarding optimal reconstruction techniques and post-operative rehabilitation are needed as the incidence and demand for this procedure is expected to increase.
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Affiliation(s)
- Lucas K Keyt
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Travis W Turner
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joshua S Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | | | - Christopher L Camp
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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