Background:Surgical management of ulnar collateral ligament (UCL) tears in nonthrowing athletes is less commonly performed, and the outcomes of that management have not been thoroughly described.Purpose:To describe the clinical outcomes of surgical management of UCL injury in nonthrowing athletes.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review was conducted on all patients who underwent UCL reconstruction or repair across a 10-year period (2010-2020), with nonthrowing athletes who had >2-year follow-up being specifically identified. Demographic variables such as age, sport participation, concomitant procedures, and graft type, as well as postoperative outcomes such as complications, patient satisfaction, return to play (RTP), and patient-reported outcomes (PROs), were recorded for the whole cohort as well as stratified by repair and reconstruction group. Data were presented as mean with standard deviation or median with range and odds ratio calculated as appropriate.Results:A total of 19 nonthrowing athletes undergoing either UCL reconstruction (n = 12) or repair (n = 7) met the inclusion criteria for the study. Sport participation included 5 cheerleaders, 4 wrestlers, 4 gymnasts, 2 lacrosse players, 1 boxer, 1 mixed martial arts fighter, and 1 football player (offensive lineman). The mean age for these patients was 20.1 ± 7.3 years with 52.6% of patients being female. The majority of tears were proximal (72.2%). Overall, 68.4% were able to RTP (58.3% UCL reconstruction; 85.7% repair) after 9.5 months (9.86 months UCL reconstruction; 9.0 months repair) with 76.9% (10/13) of the athletes returning to the same or higher level of competition.Conclusion:This study demonstrates that surgical management via either UCL reconstruction or repair can result in high rates of good-to-excellent PROs, high levels of patient satisfaction, and time to RTP that is earlier, albeit with a slightly lower overall rate of RTP, than that generally described in throwing athletes.

Timing of surgery in professional baseball—an analysis of Major League Baseball pitchers who underwent ulnar collateral ligament reconstruction

Background:The ulnar collateral ligament (UCL) is the primary static stabilizer of the medial elbow between 30° and 130° of elbow flexion. Athletes participating in overhead throwing sports, such as baseball, have the highest rate of UCL injury. High-grade injuries often require surgical intervention.Indications:Low-grade UCL injuries are typically treated nonoperatively; however, high-grade injuries can require surgical intervention for full healing and function to be achieved.Technique Description:A 5-cm incision is made from the medial epicondyle to the sublime tubercle to allow for dissection to the level of the flexor pronator fascia. Palpation is used to identify the sublime tubercle, the fascia is incised, and the flexor pronator musculature is split to reveal the underlying UCL. An ulnar anchor is placed, and the distal portion of the anterior bundle of the UCL is repaired with suture. Suture tapes were added around the suture, and a humeral anchor was placed. After all sutures were tied, the elbow was taken through the full range of motion to confirm that an isometric construct was successfully created.Results:This patient achieved a full, pain-free range of motion and a rapid return to sports (RTS) postoperatively. Current data suggest that UCL repair with suture tape augmentation may be advantageous over UCL reconstruction, as it demonstrates higher RTS rates.Discussion/Conclusion:UCL repair with suture tape augmentation is a viable alternative to UCL reconstruction in younger patients with good ligament quality who have sustained a UCL avulsion. A fast RTS and favorable postoperative outcomes can be achieved after this procedure, enabling motivated athletes to return to their sport. In older patients with UCL injuries, UCL reconstruction or hybrid UCL reconstruction with suture tape augmentation should be considered as a treatment option.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Early-career ulnar collateral ligament reconstruction in elite baseball pitchers: impact on professional career performance, longevity, and earning potential

Background:The incidence of medial ulnar collateral ligament (MUCL) reconstruction has increased significantly over the past 2 decades, especially in professional baseball. While new literature has demonstrated that MUCL repair is a viable alternative in the correct patient population with the potential for faster return to play, there have been no recent population-based studies comparing the incidence of the 2 procedures to determine how widespread the adoption of MUCL repair has become.Purpose/Hypothesis:The purpose of this study is to examine the epidemiological trends of MUCL repair compared with reconstruction on a statewide level over a 5-year period. The primary outcomes were the annual rates of MUCL repair and reconstruction. Secondary outcomes included patient demographics, institutional and surgeon volumes, and concomitant ulnar nerve transposition.Study Design:Descriptive epidemiological study.Methods:The New York Statewide Planning and Research Cooperative System database was queried for all MUCL repairs and reconstructions in New York State from 2017 to 2021 utilizing outpatient Current Procedural Terminology, 4th Revision codes. Data obtained included concomitant ulnar nerve surgery, patient age, sex, ethnicity, insurance, and laterality, as well as institutional and surgeon volume.Results:From 2017 to 2021, there were 745 MUCL surgeries performed in New York State: 242 repairs and 503 reconstructions. The incidence of MUCL repairs increased by 133% while reconstructions increased by 48% during this time period. Patients ≤16 years of age underwent MUCL repair at a significantly higher rate than college-aged patients between 19 and 22 years of age (40.9% vs 21.9%; P < .001). Female patients underwent repair at a rate 2.88 times higher than male patients. There was no difference in the type of surgery between patients with private or public insurance.Conclusion:The overall rate of MUCL surgery has increased significantly over recent years. With advances in surgical technique and technology demonstrating the potential for faster return to play, MUCL repairs have continued to grow in popularity. This trend is most evident among teenage patients.

Elbow range of motion is stable or improves following ulnar collateral ligament repairs and reconstructions.

Tips for Successful Ulnar Collateral Ligament Reconstruction.

Background:The role of forearm rotation at the time of ulnar collateral ligament (UCL) reconstruction (UCLR) graft tensioning is poorly understood.Purpose:To compare postoperative medial elbow joint gapping in cadaveric elbows after UCLR graft tensioning with the forearm in supination versus pronation.Study Design:Descriptive laboratory study.Methods:A total of 18 full-arm human specimens were stripped of soft tissue except elbow ligamentous and capsular structures. Elbows with an intact, native ligament were tested for medial elbow gapping during valgus stress at 30°, 60°, and 90° with the forearm in neutral, maximal supination, and maximal pronation. Joint gapping was determined with a 3-dimensional motion capture system and calibrated digitized points on the ulna and humerus. The UCL was transected, and reconstruction was performed using a standard docking technique. Elbows were randomized to full supination or pronation at the time of final graft tensioning, and medial elbow joint gapping was again measured for the same positions and same technique. Analysis of variance test was used to compare differences in native and postoperative medial elbow joint gapping (P < .05).Results:The position of forearm rotation did not affect the amount of medial elbow joint gapping during valgus stress at all tested elbow flexion angles with an intact, native UCL. The position of forearm rotation during UCL graft tensioning also did not affect postoperative medial elbow joint gapping during valgus stress at all tested elbow flexion angles.Conclusion:Forearm rotation with an intact UCL and at the time of UCL graft tensioning did not affect the amount of medial elbow joint gapping during valgus torque.

Objectives:To examine the epidemiological trends of UCL repair with an internal brace compared to UCL reconstruction on a state-wide level over a 5-year period. The primary endpoints were the yearly rates of UCL repairs and reconstructions. Secondary endpoints included patient demographics, institutional and surgeon volumes, and concomitant ulnar nerve transposition.Methods:In this descriptive epidemiological study, the New York Statewide Planning and Research Cooperative System (SPARCS) database contains information for every New York State ambulatory discharge. The database was queried to obtain all UCL repairs and reconstructions in New York State from 2017 to 2021, utilizing outpatient CPT-4 (Current Procedural Terminology, 4th Revision) codes. Data obtained included concomitant ulnar nerve surgery, patient age, sex, ethnicity, insurance, laterality, as well as institutional and surgeon volume.Results:From 2017 to 2021, there were 745 UCL surgeries performed in New York State. From 2017 to 2021, there was a 48% increase in UCL reconstructions in the state, compared to an even greater increase in incidence of UCL repairs during this time at 133%. In 2017, UCL repairs accounted for 26% of all UCL surgeries in the state. By 2021, UCL repairs had risen to account for 38% of all UCL surgeries. From 2017 to 2021, the total incidence of UCL surgeries increased by 72%, with an increased incidence of concomitant ulnar nerve surgery of 74%. Amongst patients 13 to 16 years of age, repairs accounted for 40% of UCL surgeries, compared to just 23.3% of UCL surgeries amongst patients 21 to 25 years of age. The two New York highest volume surgeons performed a 543% increase in UCL surgeries (16 in 2017 to 87 in 2021). UCL reconstruction was favored over repair by the two highest volume New York surgeons, though repair incidence increased over the years. There was an increased percent of UCL surgeries with concomitant ulnar nerve transposition, from 31% in 2017 to 43% in 2021.Conclusions:While the frequency of UCL reconstruction in New York State has risen in recent years, the frequency of UCL repair with an internal brace has risen at an even faster rate. UCL repairs are growing more common amongst younger patients. Amongst the two highest volume UCL surgeons in New York State, UCL reconstruction is heavily favored over repair with an internal brace, though repair incidence has increased over the years. There is a paradigm shift underway towards UCL repair with an internal brace, though the highest volume UCL surgeons still favor UCL reconstruction.

Effect of the suture augmentation on the stability and strength of ulnar collateral ligament reconstruction: The anchor and bone tunnel methods

Objectives:The primary objective was to evaluate the impact of ulnar collateral ligament reconstruction (UCLR) on MLB pitcher performance, with a specific focus on advanced metrics such as fastball velocity, spin rate, FIP (fielding independent pitching), SIERA (skill interactive earned run average), and WHIP (walks and hits per inning pitched) when compared to both pre-injury performance and a non-injured cohort of pitchers. The secondary objective was to assess the extent to which velocity and spin rate are predictive of pitcher performance. The hypotheses for the primary objective was that there would be no difference in pre-injury and post-injury performance or in post-injury performance and healthy controls. The hypothesis for the secondary objective was that both velocity and spin rate would be predictive of performance regardless of injury status.Methods:Pitchers with confirmed UCL injuries between the 2017 and 2021 MLB seasons were identified using the Pro Sports Transactions Archive and baseball-reference.com. Inclusion criteria required pitchers to have thrown at least 8.0 innings in two consecutive seasons both pre- and post-injury. A control group of healthy pitchers was age-matched at a 1:2 ratio to injured pitchers (Fig 1). Key performance metrics, including FIP, SIERA, and WHIP, were extracted from fangraphs.com, and spin rate and velocity data were collected from Baseball Savant.Principal component analysis (PCA) was used to compress several pitching performance metrics (FIP, SIERA, WHIP) into a single, comprehensive performance measure, referred to as the first principal component (PC1), where lower values indicate better overall performance. The changes in performance before and after surgery were normalized to account for age-related decline, which was controlled for by using an age-matched group of healthy control pitchers. Pearson’s correlation coefficients were calculated to assess the relationship between spin rate, velocity, and performance. Comparisons between pre- and post-surgery performance and between injured and control pitchers were conducted using independent t-tests. A power analysis was conducted to ensure a sufficient sample size to detect meaningful differences in performance outcomes, and all analyses were performed using Python 3.7 and RStudio 2023. Statistical significance was set at α = 0.05.Results:The study included 34 MLB pitchers who had undergone UCLR, with an average age at the time of injury of 27.03 ± 3.05 years. Age-matched controls (n=68) were identified for comparison, allowing for the analysis of both performance differences and the potential influence of aging on pitching metrics. Performance was first analyzed in terms of pitching volume (number of pitches and innings pitched). While the injured group showed a slight decline in innings pitched post-surgery, this difference was not statistically significant when compared to the control group (p = 0.301). Furthermore, no significant differences were found in strikeouts (p= 0.992) or hits allowed (p= 0.207) at two seasons before versus after injury. The PC1 analysis of FIP, SIERA, WHIP revealed no significant difference between injured pitchers post-surgery compared to their control counterparts (p = 0.287) (Fig 2).Spin rate and velocity were further analyzed to determine their relationship with post-surgical performance. Fastball velocity showed no significant change post-surgery (p = 0.687), and spin rate also did not significantly differ between injured and control pitchers (p = 0.876). However, both spin rate and velocity were identified as a key predictors of performance for both groups for WHIP (pspin= 0.02, pvelo= 0.04), FIP(pFIPspin= 0.003, pFIPvelo< 0.001), SIERA (pSIERAspin< 0.001, pSIERAvelo< 0.001), and PC1 (pPC1spin< 0.001, pPC1velo< 0.001) (Fig 3). There were no significant relationship between age at the time of injury and changes in performance, spin rate, or velocity, indicating that age did not influence post-operative outcomes (Pearson’s r = -0.072, p = 0.685).Conclusions:Following UCLR, MLB pitchers maintain their pre-injury level of performance, with no significant decline in fastball velocity, spin rate, or advanced statistics post-surgery. Additionally, both spin rate and velocity emerged as significant predictors of pitching performance across both injured and healthy pitchers, highlighting their potential utility as a key metric in assessing pitching effectiveness. These findings support the conclusion that UCLR is an effective intervention for MLB pitchers, allowing them to return to competitive play without significant deterioration in their key performance metrics.

Objectives: The number of medial ulnar collateral ligament (MUCL) reconstructions are increasing. The epidemiology surrounding revision MUCL reconstructions in professional baseball players has not been well defined. The purpose of this study was to report the epidemiology of revision MUCL reconstruction in professional baseball players. The authors hypothesized that the number of revision MUCL reconstructions would increase over time and that the return to sport rate at the same level of play would be less than 70%. Methods: All professional baseball pitchers who underwent revision MUCL reconstruction between 2010-2023 were identified using the MLB Health and Injury Tracking System (HITS). Rate of return and time to return to play (RTP) and return to same level of play (RTSL) was recorded and analyzed for pitchers with a minimum follow up of 2 years. Surgical variables including technique and graft choice were also recorded. Results: Overall, 191 pitchers (avg age 26.0 years), underwent revision MUCL reconstruction. The average time between primary and revision surgery was 1,381 days (45 months). 130 (68%) of these players were MLB pitchers and the other 61 (32%) were MiLB pitchers. 59% of pitchers were able to RTSL at an average of 604 ± 250 days after surgery. 2023 was the year with most revision MUCL reconstructions (n = 27) and the fewest reconstructions were performed in 2010 and 2011 (n = 4). Monthly distribution demonstrates the highest surgery months to be May (17%), June (20%), and July (17%). Hamstring tendon autograft was found to be the most commonly used graft source (n = 90, 47%), compared to palmaris longus autograft (n = 67, 35%). No significant differences were found in the types of grafts used over time ( P = .238 for palmaris and P = .133 for hamstring). In terms of tunnel configuration, both the Modified Jobe and Docking techniques were used in equal occurrence (n = 70, 37%) Conclusions: Following revision MUCL reconstruction, only 72% of professional baseball pitchers were able to return to play at any level at an average of 556 days (18 months), and only 59% were able to return to the same level of play at an average of 604 days (20 months). The average time between primary and revision MUCL reconstruction was 45 months (3.75 years). Pitchers should be counseled on the relatively low RTSL rate and the prolonged time to RTSL.

Objectives:While return to play is important for Major League Baseball (MLB) pitchers and teams, return to performance following UCL surgery using modern advanced analytic and pitch-tracking metrics has not been well studied despite their wide-spread value throughout the league. Therefore, the primary objective of this study was to evaluate return to performance using more predictive advanced analytic and pitch-tracking outcomes in the seasons following UCL surgery. Our secondary objective was to evaluate return to play (RTP) rates from November 2017 to June 2023, providing an up-to-date analysis during a period focused on value and advanced analytics. Our hypothesis was that almost all MLB pitchers will return to play by three seasons post-operatively, however a fewer percentage will have ultimately returned to performance. Overall, this study better informs current MLB players and teams about expectation regarding return to play and performance following UCL surgery, using outcomes that help drive player evaluation throughout the league.Methods:We performed a retrospective analysis on 119 MLB pitchers who underwent primary UCL reconstruction or repair from November 2017 to June 2023, and reported return to play and performance rates at one, two, and three seasons post-operatively. Return to performance analysis was then collected for 54 total MLB pitchers who met inclusion criteria (two seasons of both pre- and post-operative data) using public sources affiliated with MLB and used in previous studies. Return to performance analysis consisted of paired t-tests comparing pre- to post-operative metrics. The percentage of pitchers who returned to their pre-injury performance for each respective advanced analytic or pitch-tracking metric was also recorded for each season after surgery. Return to full performance was also evaluated. Binary logistic regression evaluated for any predictive factors.Results:Mean age was 26.5 + 3.4 years, 70.6% of included pitchers were right-handed, and 43.1% were starting pitchers. Five pitchers underwent primary UCL repair (4.2%), 113 pitchers underwent primary UCLR (94.9%), and one pitcher underwent hybrid UCL reconstruction with internal brace augmentation (0.9%). 4% returned to play at 1-year post-operatively, 79% at 2-years, and 99% at 3-years with a mean of 558 + 159 days. On average, pitchers showed a mild but significant decrease in cumulative metrics, strike zone command (Location+), and overall pitching ability (Pitching+) post-operatively. At 3-seasons post-operatively, pitchers returned to performance in pitch count (55%), xFIP (68%), fWAR (48%), velocity (76%), fastball velocity (80%), horizontal movement (81%), vertical movement (66%), Stuff+ (78%), Location+ (89%), and Pitching+ (78%) at varying degrees. Only 4%, 12%, and 28% of pitchers returned to full performance by 1-, 2- and 3-seasons post-operatively, respectively. Binary logistic regression did not identify any pre-operative factors associated with return to fWAR and full performance at 3-seasons.Conclusions:4%, 12%, and 28% of pitchers returned to full performance by 1-, 2- and 3-seasons post-operatively. Only 48% of pitchers returned to their pre-injury fWAR 3-seasons after surgery, suggesting that only half of pitchers provide the same value to teams despite presumably being fully recovered. In addition, the return to performance of each pitching metric improved season to season after returning from injury, suggesting that despite returning to play pitchers still need time to fully recover performance. Over 75% of pitchers returned to their pre-injury performance in velocity (76%), fastball velocity (80%), Pitching+ (78%), and Location+ (89%) at 3-seasons. There were no pre-operative factors that predicted return to fWAR or full performance at 3-seasons. UCL surgery restored pitcher’s rate-based metrics, velocities, movement, spin, vertical approach angles, and horizontal release points. Several modern advanced analytic and pitch-tracking metrics were characterized following UCL surgery for the first time.

Objectives:There are few studies that have closely evaluated the outcomes of ulnar collateral ligament repair and reconstruction (UCLR) in position players (PP). The objective of this study was to determine the outcome of UCLR in professional baseball players who play in non-pitcher positions, i.e. PP.Methods:The approval of the Major League Baseball (MLB) Research Committee was obtained. All PP who underwent surgery for their UCL while active on an MLB or Minor League Baseball (MiLB) team were identified using The MLB Health and Injury Tracking System. PP who underwent UCLR from 2010 to 2023 were analyzes, however for data that concerned PP time to return to professional play, only players who underwent UCL surgery from 2010 to 2021 were evaluated in order to ensure the presence of a minimum of 2-year follow-up data. Return to play (RTP) was defined as a player who played in at least 1 game at any professional level (A, AA, AAA, or MLB). Players were deemed to return to the same level of play (RTSLP) if they played in at least 1 game at the same competition level or higher that they played in prior to their UCL surgery. PP who had a time to RTP or a time to RTSLP that exceeded 800 days were excluded from any analysis that concerned the time to return to play. PPs were also compared to a cohort of professional baseball pitchers who had also undergone UCL surgery.Results:From 2010 to 2023, 241 PP underwent surgery for their UCL at a mean age of 23.4 ± 4.3 years old (Table 1). Overall, PP had their UCL surgery at approximately a mean of 3.7 ± 3.3 years after the start of their professional career (Table 1). Further, apart from the year 2020, the annual number of UCL surgeries performed in MLB and MiLB PP demonstrated an upward trend from 2010 to 2023, although no trends in the distribution of UCL surgeries across position type or between major and minor players exist.No statistically significant differences in RTP nor RTSLP rates following UCL surgery in PP existed when comparing across position type (catcher vs. infielder vs. outfielder) and across surgery type (repair vs. reconstruction vs. reconstruction with augmentation) (Table 2).PP who underwent repairs were able to RTP at a median of 221 days (IQR: 81), which was sooner than PP who underwent reconstruction surgery (median: 383 days, IQR: 316) or reconstructions with augmentation (median: 456 days, IQR: 219) (P = 0.002) (Table 3). PP with UCL repairs were also able to RTSLP sooner (median: 234 days, IQR: 64) than PP who underwent reconstructions (median: 394 days, IQR: 305) or reconstructions with augmentation (median: 462 days, IQR: 242) (P = 0.003) (Table 3). Further, infielders RTP sooner (median: 335 days, IQR: 157) than catchers (median: 396 days, IQR: 283) and outfielders (median: 412 days, IQR: 366) (P = 0.036) (Table 3). Similarly, infielders RTSLP sooner (median: 334 days, IQR: 162) than catchers (median: 470 days, IQR: 281) and outfielders (median: 426 days, IQR: 354) (P = 0.016) (Table 3).Following UCL surgery, PP were able to RTSLP, on average, more than 2 months sooner than pitchers (429 ± 177 days for PP vs 499 ± 153 days for pitchers, P < 0.001). PP who underwent repair of their UCL were able to RTSLP over 4.5 months, on average, sooner than pitchers who underwent UCL repair (269 ± 125 days for PPs vs 405 ± 153 days for pitchers, P < 0.001) and PP who underwent reconstruction of their UCL were able to RTSLP just under 50 days sooner than pitchers who had their UCLs reconstructed (450 ± 175 days for PPs vs 498 ± 151 days for pitchers, P< 0.001) (Figure 1).Conclusions:Few studies have examined PP outcome data following UCLR surgery. As such, there is little understanding as to the differences in return to game rates between various baseball non-pitcher positions as well as the differences in the time it takes to RTP and RTSLP. This study highlights that the annual number of UCLR surgeries demonstrates an upward trend. This retrospective analysis also highlights that PP with UCL repairs were able to RTP and RTSLP sooner than PP who underwent UCL reconstructions and UCL reconstructions with augmentation. Furthermore, infielders were able to RTP and RTSLP sooner than catchers as well as outfielders. The results of this study demonstrate that the type of UCL surgery as well as the player’s position does not seem to significantly impact whether or not a player actually returns to playing professional baseball, however it does impact the speed at whichthey are able to return (provided they do return to playing baseball). As such, the results of this study may be used to counsel PP regarding speed at which a return to playing baseball can be expected.

Objectives:The ulnar collateral ligament (UCL) is commonly injured in baseball pitchers due to the repetitive and high valgus torque imposed upon the UCL during pitching. Ultrasound has been used to evaluate chronic adaptations of the UCL via ulnohumeral joint gapping and UCL thickness, which has found the throwing elbow to demonstrate more joint gapping and a thicker UCL relative to the nonthrowing elbow. Collagen organization has also been used more recently to evaluate the rotator cuff, however organization of the UCL has yet to be evaluated. Therefore, the purpose of this study was to determine the chronic adaptations of UCL organization in professional baseball pitchers, with the secondary purpose of comparing UCL organization between pitchers with vs. without a history of UCL injury.Methods:Asymptomatic baseball pitchers within a single professional baseball organization were included during the 2024 preseason medical evaluation if they had not had elbow surgery within the past year and were currently cleared for full athletic participation. Included pitchers underwent bilateral elbow ultrasound evaluation by a fellowship-trained musculoskeletal radiologist. Both the throwing and nonthrowing elbows were evaluated in the resting and stressed positions, with 150 Newtons of valgus stress applied to the elbow using a Telos device. Images of the UCL were saved for later analysis of ligament organization using custom MATlab software. Mean collagen organization was compared between the dominant and non-dominant arms in the resting position, stressed position, and the change in collagen organization from stressed to resting (∆stress) using paired T tests. Comparisons were also made between the dominant elbows of pitchers with vs. without a history of UCL injury between the resting position, stressed position, and ∆stress. P values of <0.05 were considered statistically significant, and Cohen’s D effect size was calculated with effect sizes from 0.00-0.09 considered no effect, 0.10-0.29 a small effect, 0.30-0.49 a moderate effect, and effect sizes ≥0.50 considered a large effect.Results:Overall, 61 professional baseball pitchers (age: 24±2, BMI: 27±3, years professional experience: 3±2 years, 80% right-hand dominant) were included. There were 21 (34%) pitchers with history of UCL injury and 18 (30%) had underwent a prior UCL reconstruction or UCL repair. Collagen organization in the resting position did not differ bilaterally (2.99° vs. 3.16°, p=0.364), however the dominant UCL was moderately more organized than the nondominant UCL in the stressed position (2.73° vs. 3.23°, p=0.027) (Table 1). The ∆stress also did not differ bilaterally (-0.17° vs. 0.15°, p=0.192). Pitchers with a history of UCL injury had similar dominant arm UCL organization at rest, stressed, and ∆stress compared to pitchers without a history of UCL injury (Table 2).Conclusions:The dominant arm in asymptomatic professional baseball pitchers experiences increased UCL organization with 150N of valgus stress compared to the nondominant arm. These findings suggest that the UCL undergoes collagen reorganization in response to the repetitive valgus stress imposed upon it from pitching. Future research comparing symptomatic vs. asymptomatic pitchers is needed to further understand the relationship with UCL pathology.

Background: The modified Jobe and docking techniques are the most utilized ulnar collateral ligament (UCL) reconstruction techniques, with previous research demonstrating successful and equivalent outcomes at midterm follow-up. However, these techniques have not been compared with UCL repair with suture augmentation (SA), nor has longer-term follow-up been reported. Purpose: To directly compare clinical outcomes at midterm follow-up of these 3 surgical techniques: the modified Jobe, docking, and repair with SA. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-four surgical procedures for UCL repair with SA were performed by a single surgeon, each with a minimum 2-year follow-up. Patients were matched by age, gender, and handedness to patients from previously published modified Jobe and docking cohorts. The following were compared among groups: Conway Scale, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score, years played, gender, handedness, sport, position, graft type (for reconstructive techniques), future upper extremity injury, need for additional surgery, rates of ulnar nerve symptoms, and return-to-play time. Results: Patients were similar with respect to age (P = .54), gender (P = .66), handedness (P = .29), sport (P = .23), years played (P = .72), level of competition (P = .08), type of pathology (P = .23), future shoulder surgery (P = .71), and future elbow surgery (P = .61). The mean ± SD follow-up was 6.2 ± 3.9, 7.3 ± 4.6, and 5.2 ± 1.1 years in the modified Jobe, docking, and repair + SA groups, respectively (P = .66). The reconstruction groups had a greater proportion of pitchers than the repair + SA group (P = .02). Tear locations in the SA cohort were proximal in 18 (75%) and distal in 6 (25%). In the SA cohort, 13 (54%) were partial tears, 10 (42%) were complete tears, and 1 (4%) was attenuated. The repair + SA cohort had a significantly greater proportion of proximal tears than the docking cohort (P = .03). No difference was identified among techniques in results on the Kerlan-Jobe Orthopaedic Clinic score (P = .70) or Conway Scale (P = .06). The UCL repair + SA cohort returned to sports 4 months earlier than the reconstruction cohorts (P = .0001). Conclusion: No differences in outcomes scores or return-to-play rates were found when the modified Jobe and docking UCL reconstruction techniques were compared with the UCL repair + SA technique at >5-year mean follow-up; however, the SA group returned to sport 4 months earlier on average. Given the similar outcomes among groups, all 3 techniques are viable treatment options for UCL injuries.

BackgroundUlnar collateral ligament (UCL) injuries are common among javelin throwers and surgical intervention is the preferred treatment method. Universally accepted javelin-specific return-to-sport (RTS) guidelines would benefit healthcare providers in returning athletes safely to the sport.PurposeTo systematically assess the current literature for RTS criteria and identify gaps and opportunities for developing javelin-specific return to throwing (RTT) and RTS recommendations.Study DesignSystematic reviewMethodsA Boolean search related to javelin, UCL surgery, RTS was performed using PubMed/Medline, ProQuest, PEDro, Scopus, CINAHL, Cochrane, EMBASE, and SPORTDiscus databases. Studies published between 2000, and May 2024 were included if they had a population of javelin athletes of any level of competition who underwent UCL reconstruction (UCLR) with a minimum follow-up of one year.ResultsFour studies met inclusion criteria for this review with a total population of 34 athletes (mean age, all studies: 19.7 years) and an average follow-up period of 3.8 years for all studies. Of the 34 athletes, 82% returned to any level of play at an average of 11.2 months post-surgery, with 70.1% returning to their previous level of competition. Only one study provided a specific RTT program, which included stepwise progressions for number, effort, quality, and distance for throws and javelin weights used for each program phase.ConclusionThis review found no studies providing guidelines for RTT/RTS criteria for javelin athletes following UCLR that emphasized objective measures of rehabilitation progress and completion. Further research on post-surgical physical function and subsequent programming tailored to the demands of javelin athletes is needed to guide safe return to sport.Level of Evidence3a

Increased Pitch-Specific Velocity, Spin Rate, and Horizontal Movement Lead to Increased Odds of Undergoing Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers Using Baseball Savant Data.

Favorable Outcomes Following Elbow Ulnar Collateral Ligament Reconstruction and Repair, Though Repair Associated with Increased Risk of Revision Surgery

This study aimed to report clinical and patient-reported outcomes collected in a registry after thumb ulnar collateral ligament (UCL) reconstruction with a free tendon autograft. Furthermore, the patient-reported outcomes of patients with persistent instability after reconstruction and patients with concomitant metacarpophalangeal joint arthritis diagnosed during surgery were analyzed. Patients undergoing reconstruction with a tendon autograft between December 2011 and February 2021 were included. Michigan Hand Outcomes Questionnaire (MHQ) scores at baseline were compared with those at 3 and 12 months after surgery. Stability was tested at 3 months after surgery. Tip and key pinch strength and metacarpophalangeal joint range of motion were measured at baseline and 12 months after surgery. We included 31 patients with thumb UCL insufficiency or failed UCL surgery who underwent reconstruction. The MHQ total score improved significantly from 62 at baseline to 75 at 3 months and continued to increase to 84 at 12 months after surgery. The MHQ function and pain scores improved significantly from intake to 3 and 12 months after surgery. Twenty-six of 31 patients (84%) regained postoperative metacarpophalangeal stability. Key pinch strength improved significantly 12 months after surgery from 5.2 kg at baseline to 6.4 kg at 12 months. The MHQ total, pain, and function scores of patients with persistent instability remained similar from baseline to 12 months after surgery. In four patients with metacarpophalangeal arthritis, the MHQ total and pain score improved significantly from baseline to 3 and 12 months after surgery. Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft. Although the sample size of patients with thumb metacarpophalangeal arthritis diagnosed during surgery was small, they reached adequate patient-reported outcomes at 12 months after surgery. Therapeutic IV.