Operative Management of Elbow UCL Insufficiency in Adolescent Athletes Age 18 Years and Younger

Abstract

Objectives:The incidence of ulnar collateral ligament (UCL) insufficiency of the elbow has drastically increased in the adolescent population over the last decade due to widespread participation in overhead athletics. Previous reports suggest clinical outcomes in teenage athletes are inferior to results in higher-level adult athletes. We hypothesized that UCL reconstruction using the docking technique would result in improved outcomes in this age group.Methods:46 adolescent athletes (mean age 17 years, range 12-18 years) underwent UCL reconstruction using the docking technique. The majority of patients were baseball players; there were three gymnasts and three javelin throwers. Retrospective review revealed each patient had a history and physical exam consistent with UCL injury along with advanced imaging demonstrating corresponding UCL pathology (24 distal tears, 22 proximal tears). Patients were evaluated at a minimum of 2 years postoperatively based on their ability to return to athletic activity. Clinical outcomes were classified using the Conway Scale, the Andrews-Timmerman Score, and the Kerlan-Jobe Orthopaedic Clinic (KJOC) Score.Results:At most recent follow-up, 89% (41/46) of patients had excellent results using the Conway Scale. There was one good, two fair and two poor results. One fair result was noted in a revision case and the two poor results occurred in patients who had concomitant capitellar OCD lesions. UCL tear location did not affect clinical outcome. There were four postoperative complications in four patients (two gymnasts and two javelin throwers) who developed ulnar neuritis following reconstruction. The average Andrews-Timmerman Score was 86.7 and the mean KJOC score was 88.Conclusion:The docking technique results in favorable clinical outcomes in adolescent athletes with UCL insufficiency at a minimum of 2 years postoperatively. Overall, results were better than previously published reports in this age group and this may be attributed to technique specific factors. Patients with concomitant intraarticular pathology should be counseled preopreratively that they may experience inferior clinical outcomes. Additionally, gymnasts and javelin throwers may be at increased risk for postoperative complications due to increased stress on the medial elbow.