Ulnar Collateral Ligament Reconstruction Research Articles

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

To assess the risk of revision surgery following repair versus reconstruction of the medial ulnar collateral ligament (UCL) of the elbow in a national sample of patients in the United States. This was a retrospective cohort study of young patients (≤35 years old) who underwent primary UCL reconstruction or repair for an isolated medial UCL injury of the elbow from October 2015 through October 2022 in a large national database (PearlDiver). Patient demographic data, comorbidities, surgical details, and concomitant ulnar nerve procedures were collected. Time-to-event analyses were used to assess the risk of revision UCL surgery between groups. Two-year complication rates, including ulnar neuropathy, were also assessed. In total, 1,820 patients (69.9% reconstruction, 30.1% repair) with an average follow-up of 2.9 years met inclusion criteria. The estimated 2-year revision-free survival (95% confidence interval [CI]) was 99.5% (99.1%-99.9%) for UCL reconstruction compared to 97.9% (96.4%-99.3%) for UCL repair (unadjusted Log-rank p=0.032). UCL repair remained associated with an increased risk of revision UCL surgery after adjusting for confounding variables (hazard ratio 2.94, 95% CI 1.07-8.09, p=0.037). Complication rates were similar between reconstruction and repair, including the incidence of ulnar neuropathy (13.8% vs. 14.5%, p=0.78). In this study, we found that UCL repair was associated with a significantly higher risk of revision UCL surgery than UCL reconstruction in a national sample. Importantly, however, overall failure rates were low and complication rates were similar between procedures. These findings support the overall favorable outcomes of UCL repair, while suggesting it may not necessarily be the optimal treatment for all patients. 3 - retrospective cohort study.

Nonoperative Management of Sublime Tubercle Fractures in Adolescent Throwing Athletes: Improved Results With Cast Immobilization.

Avulsion fractures of the sublime tubercle of the ulna are a cause of medial elbow pain and instability in overhead athletes. To compare outcomes after sublime tubercle avulsion fracture managed as a fracture (with cast immobilization) versus a soft tissue injury (without immobilization and with early range of motion [ROM]) to determine how to achieve the best outcomes for these injuries in adolescent throwing athletes. Cohort study; Level of evidence, 3. A multicenter retrospective review using an institutional database query of radiology reports to identify sublime tubercle fractures between July 2005 and December 2020 was performed. Inclusion criteria were baseball players aged ≤19 years, fracture identified on ≥1 imaging study (radiograph, computed tomography, or magnetic resonance imaging), and ≥24 months of follow-up (unless failure of management occurred earlier). Fractures were classified as simple or complex injuries and then grouped according to management strategy: cast or early ROM. Data collected included patient characteristics, clinical presentation (injury mechanism and acuity), initial treatment, and outcomes (complications, final ROM, patient-reported symptoms, radiographic union, and return to activities or sport). A total of 13 baseball players (6 in the cast cohort and 7 in the early ROM cohort) with a mean age of 16.5 years (range, 15-19 years) met the inclusion criteria, with a mean follow-up of 4.1 years (range, 2.0-6.7 years) in the cast cohort and 3.8 years (range, 2.1-7.4 years) in the early ROM cohort. All injuries were classified as simple fractures. Five patients (83%) in the cast cohort achieved radiographic union, return to sports, and symmetric ROM, compared with only 2 patients (29%) in the early ROM cohort who achieved the same without having to undergo ulnar collateral ligament reconstruction (P = .026). The present study demonstrated that, whereas management of sublime tubercle avulsion fractures in adolescents via early ROM had a high failure rate, a mean of 4 weeks of immobilization led to a high rate of return to sports with successful union of the avulsed fragment. Unlike purely ligamentous injuries, bony avulsions may not necessarily require surgical intervention for adolescent patients to return to baseball.

Fastball Quality After Ulnar Collateral Ligament Reconstruction Of The Major League Baseball Pitchers: A Case-Control Study With Advanced Pitching Data

Fastball Quality After Ulnar Collateral Ligament Reconstruction Of The Major League Baseball Pitchers: A Case-Control Study With Advanced Pitching Data

Risk Factors and Injury Prevention in the Throwing Athlete

Arm injuries are the most common throwing injury, with growing concern as the most severe injuries, such as UCL reconstruction continue to rise. Furthermore, throwing injuries are frequently recurrent suggesting once injured, players are at increased risk for another arm injury. The increase in injury rates and severity has been attributed to increases in pitching volume and year around participation, and specialized training. Thus, initial efforts to prevent arm injuries by USA Baseball and Little League have focused on the extrinsic factor of pitching exposure in the form of pitch counts, yet arm injury rates have stayed constant. Therefore, injury prevention strategies should include extrinsic factors, and address modifiable, intrinsic factors that are associated with arm injury. Collectively addressing factors such as shoulder range of motion and strength deficits, trunk and lower extremity function, and implantation of training programs yields a comprehensive approach to reduce arm injury rates. We will use a directed acyclic graph (DAG) to organize how the internal factors (i.e. fatigue, injury history, ROM and strength) interact with the external factors (i.e. training load and pitching exposure) and how together they are thought contribute to potential injury and inform arm injury reduction strategies. This will provide a roadmap to build adaptable arm injury reduction strategies to improve the modifiable physical factors in context of the external factors that change over time and between throwing athletes. Level of EvidenceLevel V, Expert Opinion

Return to play after UCL injury in gymnasts

ABSTRACT Background Injuries to the ulnar collateral ligament (UCL) are commonly reported in traditional overhead sports. Conversely, there is a lack of evidence outlining management and return to play (RTP) outcomes for gymnasts. This study aimed to evaluate RTP and patient reported outcomes (PROs) in gymnasts after operative and non-operative treatment of UCL injuries. Methods Gymnasts who presented with UCL injury and underwent operative and non-operative treatment were evaluated. Patient reported outcomes were collected via telephone: Conway-Jobe Scale, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) Score, Mayo Elbow Performance (MEP) Score, quick DASH (qDASH) and Timmerman-Andrews (TA) Elbow Score. Results Nine patients met inclusion criteria and were available for follow-up. Five were initially treated operatively and 4 were initially treated non-operatively. The operative group initially consisted of 3 ulnar collateral ligament reconstructions (UCLR) and 2 UCL repairs with internal bracing. One patient crossed over to the operative group after failing non-operative treatment and underwent UCLR 4 months post injury. Overall, 66.7% and 100% of operatively and non-operatively treated gymnasts were able to return to play, respectively. At final follow-up, the operative groups’ mean KJOC, MEP, TA and qDASH scores were: 68.4 ± 7.7, 97.5 ± 2.7, 90.8 ± 10.7 and 1.9 ± 3.0, respectively. For the non-operative group, the mean scores were 67.4 ± 9.0, 71.7 ± 5.8, 71.7 ± 14.4 and 11.4 ± 9.9, respectively. Treatment satisfaction for the operative group was 81.7 ± 27.5 compared to 80.6 ± 34.5 in the non-operative group. Odds ratios indicated no differences between groups. Conclusion Both operative and non-operative interventions for UCL injuries in gymnasts can provide favorable outcomes with respect to return to play and subjective patient-reported outcomes. Further research is warranted to determine optimal treatment, especially regarding indications for operative vs. nonoperative treatment, of UCL injury based on injury severity and location in gymnasts. Level of Evidence Level III

Ulnar Collateral Ligament Injuries in Overhead Athletes: Diagnosis, Management, and Clinical Outcomes.

Ulnar collateral ligament (UCL) injuries are a common source of pain and disability in overhead and throwing athletes. The prolonged nature of healing often results in notable time lost from competitive sports regardless of the definitive management strategy. A thorough history and physical examination are critical in the diagnosis of UCL injury and understanding patient goals and expectations. In carefully selected patients, nonsurgical management, including rest and slow progression back to activities, can result in successful return to sport. Recent literature has suggested that administration of platelet-rich plasma may be effective in aiding in the healing process, particularly in proximal and partial-thickness tears; however, additional study is warranted. UCL reconstruction has been the benchmark for tears not amendable to nonsurgical treatment, with flexor-pronator complex preservation being important. UCL repair has historically been most commonly used in partial avulsions, but indications have yet to be completely well defined. Knowledge regarding appropriate UCL treatment continues to evolve with patient-specific treatment being essential.

Fastball Quality After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

Background: The ulnar collateral ligament (UCL) is essential for elbow stability during pitching. In professional baseball, the fastball (FB) is the most commonly used pitch, making postrecovery FB performance after UCL reconstruction (UCLR) a crucial aspect to consider. Hypotheses: (1) Pitchers undergoing UCLR would show no significant changes in performance metrics compared with nonoperated pitchers with similar FB velocity and spin rate, and (2) no significant variance would be found in these metrics within the operated pitchers concerning their preinjury anthropometric characteristics and pitching performance metrics. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 91 Major League Baseball (MLB) pitchers who underwent primary UCLR between January 1, 2015, and December 31, 2021. A matched 1:1 control group of MLB pitchers without UCLR injuries was established. Publicly available pitch metrics and anthropometric data were compared between the study and control groups. Results: Disparities in several performance metrics emerged during the first postreturn year (PRY1), including FB use percentage (P = .029), fielder independent pitching (FIP) (P = .021), and standardized FB runs above average per 100 pitches (wFB/C) (P < .001). Subgroup analysis within the UCLR group revealed a negative correlation between presurgery mean FB velocity and its subsequent change (P < .001) and a positive correlation with changes in FIP (P = .025) from the index year to PRY1. A negative correlation was observed between FB use percentage in the index year and its change by PRY1 (P = .002). By the second postreturn year, no significant differences were found in these performance metrics. No factors were significantly related to prolonged recovery time. Conclusion: Although FB velocity and spin rate remained consistent, significant differences were observed in FB use percentage, FIP, and wFB/C in PRY1. However, by second postreturn year, these differences were no longer significant. No specific risk factors were identified concerning prolonged recovery time between pre-UCLR FB pitching metrics and the physical anthropometric data. These results suggest that although the short-term postsurgery period may affect more specialized pitching metrics, the basic pitching performance metrics, as hypothesized, remain largely unaffected by UCLR.

Hand size association with ulnar collateral ligament reconstruction in professional baseball players

BackgroundUlnar collateral ligament (UCL) injuries in professional baseball remains a significant problem with debate as to which are the greatest risk factors. Currently, it is unknown if hand size should be considered a predictor for UCL injury. A larger or smaller hand size could have implications on fatigue of the forearm musculature and thus varying amounts of strain seen by the ulnar collateral ligament. Hypothesis/PurposeThe purpose of this study was to investigate if there is a correlation between hand size and history of UCL tear requiring a reconstruction. We hypothesize that a smaller hand size will be correlated with higher UCL reconstruction rates in professional baseball players. MethodsOne-hundred and eighty-nine professional players from one Major League Baseball organization were recruited in this retrospective study. Four different measurements were used for hand size including: the distance from the tip of long finger to wrist crease (closed fingers), the distance from the thumb tip to the small fingertip (closed fingers), the distance between thumb tip and small fingertip (spread fingers) and a modified Nirschl measurement (closed fingers). Statistical analysis including t test, Chi-Square test, Pearson correlation, and binary logistic regression were performed to determine the statistical significance between these hand size measurements and a history of UCL reconstruction. ResultsThere were 25/189 (13.2%) of players with a history of UCL reconstruction surgery. The mean age of UCL reconstruction group (23.6 ± 3.3years) was younger than the non-reconstruction group (26.2 ±3.6) (p=0.001). Statistical analysis demonstrated the distance between thumb tip and small fingertip (spread fingers) was smaller in the UCL reconstruction group compared to the non-reconstruction group (20.33 ± 1.18cm vs 20.98 ± 1.03cm; p=0.024) and the modified Nirschl measurement (closed fingers) was shorter in the UCL reconstruction group (14.45 ± 0.7cm vs 14.86 ± 0.91cm; p=0.013). Findings were most notable in players younger than 21 years old with UCL reconstruction rates of (57.1%) versus players older than 21 years (9.7%) (p<0.001). Statistical analysis demonstrated a correlation and regression between injury probability and hand measurements (p=0.01). ConclusionThis study demonstrated that a smaller hand size did correlate with a history of UCL reconstruction in this professional baseball population of players. Further studies are warranted to investigate these associations.

Ulnar Collateral Ligament Reconstruction Utilizing a 3-Strand Palmaris Tendon Autograft With a Hybrid Linear Construct

The integrity of the medial ulnar collateral ligament (UCL) of the elbow is vital for the throwing athlete. Although newer techniques exist, reconstruction remains the gold standard for full-thickness UCL tears. An increase in throwing velocity, inadequate recovery, and early sports specialization have contributed to increased rates of UCL injury. As increasing numbers of athletes undergo UCL reconstruction, we continue to search for the optimal technique to return athletes to the same level of competition. We present a UCL reconstruction utilizing a 3-stranded palmaris longus tendon autograft with an inlay linear construct.

Outcomes and performance following posteromedial elbow débridement in major league baseball players

Overhead athletes are particularly susceptible to elbow valgus extension overload syndrome and development of pathologic changes in the posteromedial elbow. Though arthroscopic débridement/osteophyte resection is frequently performed, few studies have analyzed the outcomes of this procedure and none have specifically addressed professional level athletes. We hypothesized that following posteromedial elbow débridement, Major League Baseball (MLB) pitchers would exhibit a higher rate of ulnar collateral ligament (UCL) reconstruction than baseline incidence in the existing literature, along with a decline in pitching performance. Using publicly accessible websites, MLB athletes undergoing posteromedial elbow débridement from 2007 to 2022 were identified. Demographic information, procedure details, return to play (RTP) information, return to the disabled/injured list (DL/IL), subsequent UCL reconstruction, and pitching statistics were analyzed. Pitching performance metrics included earned runs average, walks plus hits per innings pitched, innings pitched, and fastball velocity. A total of 39 MLB players, including 26 pitchers, were included. Within the first three seasons after surgery, 82.1% (n=32) of players returned to play at the MLB level at a mean time of 176.1±69days. Pitchers exhibited a RTP rate of 76.9% (n=20) at 175.8±16days. A total of 38.5% (n=10) of pitchers returned to the DL/IL for elbow-related issues within three seasons. Subsequent UCL reconstruction was seen only in pitchers, with a frequency of 19.2% (n=5). No statistically significant differences between single season preoperative/postoperative pitching metrics were identified. A small but significant (P<.05) decrease in fastball velocity (94.4 vs. 92.84; P=.02) was observed over a three-season comparison. Contrary to our hypothesis, this study demonstrates that posteromedial elbow débridement is a viable surgery in MLB athletes, with RTP rate of 82.1% and no increase in rate of UCL reconstruction. Furthermore, there was no significant difference in single season preoperative and postoperative statistical pitching performance. However, over three years postoperatively, there was a 38.5% rate of return to the DL/IL for ongoing elbow ailment and a significant decrease in pitch velocity, raising some concern over the longevity of postoperative improvements.

Understanding How ChatGPT May Become a Clinical Administrative Tool Through an Investigation on the Ability to Answer Common Patient Questions Concerning Ulnar Collateral Ligament Injuries.

The consumer availability and automated response functions of chat generator pretrained transformer (ChatGPT-4), a large language model, poise this application to be utilized for patient health queries and may have a role in serving as an adjunct to minimize administrative and clinical burden. To evaluate the ability of ChatGPT-4 to respond to patient inquiries concerning ulnar collateral ligament (UCL) injuries and compare these results with the performance of Google. Cross-sectional study. Google Web Search was used as a benchmark, as it is the most widely used search engine worldwide and the only search engine that generates frequently asked questions (FAQs) when prompted with a query, allowing comparisons through a systematic approach. The query "ulnar collateral ligament reconstruction" was entered into Google, and the top 10 FAQs, answers, and their sources were recorded. ChatGPT-4 was prompted to perform a Google search of FAQs with the same query and to record the sources of answers for comparison. This process was again replicated to obtain 10 new questions requiring numeric instead of open-ended responses. Finally, responses were graded independently for clinical accuracy (grade 0 = inaccurate, grade 1 = somewhat accurate, grade 2 = accurate) by 2 fellowship-trained sports medicine surgeons (D.W.A, J.S.D.) blinded to the search engine and answer source. ChatGPT-4 used a greater proportion of academic sources than Google to provide answers to the top 10 FAQs, although this was not statistically significant (90% vs 50%; P = .14). In terms of question overlap, 40% of the most common questions on Google and ChatGPT-4 were the same. When comparing FAQs with numeric responses, 20% of answers were completely overlapping, 30% demonstrated partial overlap, and the remaining 50% did not demonstrate any overlap. All sources used by ChatGPT-4 to answer these FAQs were academic, while only 20% of sources used by Google were academic (P = .0007). The remaining Google sources included social media (40%), medical practices (20%), single-surgeon websites (10%), and commercial websites (10%). The mean (± standard deviation) accuracy for answers given by ChatGPT-4 was significantly greater compared with Google for the top 10 FAQs (1.9 ± 0.2 vs 1.2 ± 0.6; P = .001) and top 10 questions with numeric answers (1.8 ± 0.4 vs 1 ± 0.8; P = .013). ChatGPT-4 is capable of providing responses with clinically relevant content concerning UCL injuries and reconstruction. ChatGPT-4 utilized a greater proportion of academic websites to provide responses to FAQs representative of patient inquiries compared with Google Web Search and provided significantly more accurate answers. Moving forward, ChatGPT has the potential to be used as a clinical adjunct when answering queries about UCL injuries and reconstruction, but further validation is warranted before integrated or autonomous use in clinical settings.

Poster 169: Preliminary Outcomes of Revision UCL Repair With Suture Tape Augmentation for Failure of Primary UCL Reconstruction in Professional and Collegiate Pitchers

Objectives: Injury of the ulnar collateral ligament (UCL) is common in baseball players and pitchers, in particular. The gold standard surgical treatment has been UCL reconstruction with autograft, although, UCL repair with collagen-coated suture tape has shown promise as an alternative recently. The outcomes of UCL reconstruction and UCL repair are well-studied, demonstrating high rates of return to sport and a predictable postoperative course of recovery. However, revision UCL reconstructions with allografts do not demonstrate comparable outcomes when compared with primary procedures. This pilot case series reports on the preliminary outcomes of collegiate and professional pitchers who underwent revision UCL repair with collagen-coated suture tape following failure of primary UCL reconstruction. Methods: We performed a retrospective query of a prospectively collected data repository to identify patients at our institution who had undergone UCL repair with internal brace. Additional inclusion criteria included: 1) prior failed UCL reconstruction with autograft; 2) aged between 15 and 45 years; 3) at least 1-year post-operative. From the included cohort, we collected demographic, clinical, and surgical data from the electronic health record. We further collected patient-reported outcomes data using either a web-based database platform or via telephone, including the American Shoulder and Elbow Surgeons Elbow assessment form (ASES-E; satisfaction, pain, and function subscales), the Kerlan Jobe Orthopaedic Clinic Shoulder and Elbow score (KJOC), Andrews Carson score, and information on return-to-sport timing and success. To evaluate outcomes, we reported the proportions of athletes that were able to successfully return-to-sport at the preinjury level or higher as well as return-to-sport timing and level of competition. Additionally, we reported summary statistics for patient-reported questionnaires evaluated at follow-up (ASES-E, KJOC, and Andrews Carson). Results: A total of 10 patients met inclusion criteria, and all were professional or collegiate pitchers at the time of their revision UCL repair surgery (40% professional and 60% collegiate). The mean follow-up time was 3.0 years (Table 1; range: 1-5 years). Table 1 shows complete return-to-sport data. All patients were able to return-to-sport at the same or higher level, and the mean time from surgery to return-to-sport was 9.3 months. Table 2 shows complete patient-reported outcomes data. Mean scores on elbow-related function questionnaires were high (ASES-E Function = 35.8 out of a maximum best of 36; KJOC = 88.3 out of a maximum best of 100; Andrews Carson = 94.5 out of a maximum best of 100) and mean pain scores were low (ASES-E Pain = 1 out of a maximum worst score of 50). Conclusions: This pilot case series demonstrated promising results of a novel UCL repair approach utilizing collagen-coated suture tape for high-level pitchers with recurrent medial elbow instability following initial UCL reconstruction with autograft. Specifically, we found excellent return-to-sport success and patient-reported outcomes in this preliminary cohort. Further study is warranted with larger sample sizes to further evaluate outcomes following revision of UCL reconstruction with UCL repair utilizing internal bracing.

Poster 381: Biomechanical Risk Factors for Ulnar Collateral Ligament Injury and the Ability to Readily Recognize Them

Objectives: Three biomechanical traits which are concerning for potential injury to the ulnar collateral ligament (UCL) in baseball players include: the Tommy John Twist, an open front (landing) foot position, and early swinging gate (opening) of the hips. Our objective was first to determine if these risk factors were more commonly found in those who had undergone an ulnar collateral ligament reconstruction (UCLR) versus controls and second to determine if viewing standard video and/or broadcast video would allow a predictable identification of these three factors. Our hypothesis was the three aforementioned factors would be present in a higher frequency in those with previous UCLR and that the reviewers would have at least a substantial level of agreement of identification. Methods: Twenty (20) consecutive professional pitchers who underwent UCLR (height=188.0±6.9cm; weight=96.5±8.1kg; throw left=5; throw right=15) were analyzed and compared to 20 controls (height=188.5±6.0cm; weight=94.5±9.1kg; throw left=4; throw right=16) with similar height and weights and handedness (p≥0.46). 3 fastballs from 3 separate games were obtained for each pitcher from publicly available video and adjusted to a very low speed for review. The 3 factors analyzed included: Tommy John Twist (at the maximum abducted, externally rotated position of the shoulder, the palm (and ball) faces center field), open front foot position (front foot not aligned with the catcher or closed [open to first base side for a right hander or third base side for a left hander]), and early swinging gate of the hips (at the maximum abducted, externally rotated position of the shoulder, the hips have already rotated and are facing home plate). 6 reviewers with experience and current positions in professional baseball and familiarity with pitching biomechanics performed the video reviews. Both the number of subjects and the number of reviewers was appropriately powered. Each pitch from each of the pitchers was graded: yes, indeterminant, or no, for each of the biomechanical factors of interest. Reviews were conducted on two separate occasions by each reviewer 1 month apart. The frequency of responses was calculated and compared between the UCLR and control groups. Inter-rater agreement was calculated via Fleiss’ Kappa (K). Agreement (K) was interpreted as: ≤ 0=poor, 0.01-0.20=slight, 0.21-0.40=fair, 0.41-0.60=moderate, 0.61-0.80=substantial, and 0.81-1.00=almost perfect. Results: There was significantly greater percentages of “yes” responses (p&lt;0.01) in the UCLR group versus the control group for Tommy John Twist (9%), open front foot position (9%), and early swinging gate of the hips (14%) for both rating sessions (Table 1). Agreement was similar (fair to moderate) for control and UCLR pitchers for identifying Tommy John Twist (K=0.28-0.48). However, the agreement for UCLR pitchers was moderate (K=0.41-0.46) for all 9 pitches of Early Swinging Gate, while the agreement for control pitchers was fair (K=0.29-0.38) for 8 of 9 pitches. Finally, the agreement for UCLR pitchers was moderate to substantial (K=0.50-0.67) for Open Front Foot while agreement for control pitchers was fair to moderate (K=0.27-0.46). Conclusions: The identification of particular, concerning high-risk biomechanical factors in those who have had UCLR was more common and identifiable versus controls. Presence of any of these factors in a pitcher could warrant a discussion of correctability. However, based on the range of indeterminant responses of 5-25%, along with Kappa values of fair to substantial, the shortcomings of video quality and position of the camera angle suggest an improved and reproducible method for video analysis should be employed.

Poster 163: Direct Comparison of Modified Jobe and Docking Reconstructions to UCL Repair with Internal Brace at Mid-Term Follow-Up

Objectives: The modified Jobe and Docking techniques are the most utilized ulnar collateral ligament (UCL) reconstruction techniques with prior research demonstrating successful and equivalent outcomes at midterm follow-up. More recently, UCL repair augmented with the Internal Brace (IB) has been investigated as a possible alternative with cadaveric studies demonstrating improved time-zero biomechanics and favorable clinical results at early follow-up, with possible earlier return to play. However, there has been no comparison between UCL repair with IB and these reconstruction techniques, nor has longer term follow-up been reported. The purpose of this study was to directly compare clinical outcomes at mid-term follow-up of these three surgical techniques: the modified Jobe, Docking, and repair with IB when performed by a single surgeon. Methods: Nineteen UCL repair with IB surgical procedures 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. Conway Scale, Kerlan-Jobe Orthopaedic Clinic (KJOC) score, years played, gender, handedness, sport, position, graft type (for reconstructive techniques), future upper extremity injury, and need for additional surgery were compared between groups. Continuous variables are displayed as mean ± standard deviation unless otherwise indicated, with groups compared using a Kruskal-Wallis test. Categorical variables are displayed as count (percentage total), with pairwise comparison between groups performed using a Fisher’s exact test. When there were greater than 2 categorical variables, groups were compared with chi square test for trend. For multiple comparisons of categorical variables, the lowest P value is shown in Tables 1 and 2, with no comparison reaching P &lt; 0.05, which was considered significant. Results: Patients were similar with respect to age ( p=0.52), gender ( p&gt;0.60), handedness ( p&gt;0.17), sport ( p&gt;0.16), position ( p&gt;0.07), years played ( p=0.69), level of competition ( p&gt;0.26), future shoulder surgery ( p&gt;0.65), and future elbow surgery ( p&gt;0.48) (Table 1). The mean follow-up was 5.7 ± 3.5 years, 7.4 ± 4.7 years, and 5.4 ± 1.2 years in the modified Jobe, Docking, and repair with IB groups, respectively ( p=0.55). No difference was identified between techniques in KJOC scores (modified Jobe, 73.5 ± 23.6; Docking, 74.5 ± 25.5; repair with IB, 75.5 ± 25.3) or Conway Scale (return to play, any level: 73% vs. 84% vs.78%, p&gt;0.11) (Table 2). Conclusions: No differences in outcomes scores or return to play were found when the modified Jobe and Docking UCL reconstruction techniques were compared with the UCL repair with internal brace technique at greater than 5-year average follow-up. Given the similar outcomes between groups, all three techniques are viable treatment options for UCL injuries. Sufficient clinical equipoise exists in surgical decision making, with repair being a durable option in the proper patient.

Paper 21: Anatomic Medial Ulnar Collateral Ligament Reconstruction with Internal Brace Augmentation in Throwing Athletes

Objectives: Injury to the Medial Ulnar Collateral Ligament (MUCL) is a common setback experienced by many throwing athletes often requiring reconstruction with 12-18 months of rehabilitation. Current reconstructive techniques fail to anatomically restore the MUCL which may contribute to the prolonged course of rehabilitation. In recent years, we described an anatomic MUCL reconstruction with internal brace augmentation which demonstrated improved biomechanical strength when compared to the docking technique in cadaveric specimens. The purpose of this study was to evaluate the postoperative course of both amateur and professional throwing athletes that underwent anatomic MUCL reconstruction with internal brace augmentation. We hypothesized that throwers would return to the same level of play and that return to play (RTP) would be a shorter duration compared to current reported outcomes. Methods: In this surgical technique, the native MUCL is formally repaired. The graft and a suture tape are folded over a suspensory loop and secured in a socket of the medial epicondyle of the humerus to maximize tendon to bone contact. On the ulnar side, the graft and internal brace are secured proximally by two suture anchors on either side of the sublime tubercle and further secured across the sublime tubercle ridge distally to re-create the anatomic triangular insertion of the native ligament. All surgeries were performed by a single surgeon. Patient reported outcomes in addition to date of RTP, level of play, and functional outcomes were retrospectively gathered. All patients initially followed an Accelerated Rehabilitation Protocol and were converted to a Standard Paced protocol if setbacks were encountered. Results: A total of 26 baseball players underwent primary (n=23) or revision (n=3) MUCL reconstruction with the Anatomic Technique. Of these, 15 were professional and 11 were amateur athletes. 92% of throwers returned to play at a mean of 9.9 months following reconstruction. 89% were able to advance through the accelerated postoperative protocol without issues and 85% returned to the same role and level of play. Post injury KJOC scores improved from 41 to 86.9 and SANE scores improved from 32.5 to 95.5. No significant difference was identified in pre-injury versus post-reconstruction throwing velocity, ball spin rate, or horizontal/vertical ball movement. Conclusions: Anatomic reconstruction of the MUCL with internal bracing is a viable option for MUCL injuries. Advantages include increased tendon-bone contact of the reconstruction, multiple fixation points, and anatomic restoration of the MUCL. This technique allowed an expedited return to sport for these baseball athletes.

Paper 20: Clinical Outcomes of Ulnar Collateral Ligament Repair with Internal Brace Versus Ulnar Collateral Ligament Reconstruction in Competitive Athletes

Paper 20: Clinical Outcomes of Ulnar Collateral Ligament Repair with Internal Brace Versus Ulnar Collateral Ligament Reconstruction in Competitive Athletes

Revision Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Reconstruction With Autograft and Button Suspension.

Recurrent instability following thumb ulnar collateral ligament repair or reconstruction may result in pain and poor function. The use of certain suture anchors during the index procedure may predispose patients to the development of osteolysis and subsequent fixation failure. In this article, we describe an effective surgical technique for revision reconstruction of ulnar collateral ligament injuries using autograft and suture suspensionplasty. This technique restores joint stability and allows functional recovery with minimal postoperative complications.

Changes in Pitch Velocity and Selection in Major League Baseball Pitchers Following the Ulnar Collateral Ligament Reconstruction.

The ulnar collateral ligament (UCL) is a soft-tissue stabilizer of the elbow, that is commonly injured among baseball pitchers due to excess valgus stress in overheadthrowing motions. The location of a UCL tear typically ranges from the central aspect of the ligamentto an avulsion-type injury at its proximal insertion site on the medialepicondyle of the humerus, or its distal insertion site on the ulna. The effect of UCL reconstruction on pitching performance has become a well-studied topic in medical literature. In our study, we aimed to identify general performance patterns amongst those having undergone UCL reconstruction surgery. Data for patients with UCL reconstruction performed between 2010 and 2020 were extracted from publicly available databases. Pitching data was extracted from Brooks Baseball, a publicly available database for Major League Baseball (MLB) player statistics. We identified patients who played at least one full season after surgery and rehabilitation. Patient characteristics were evaluated for intergroup differences. Of 109 patients with UCL reconstruction, 87 were included in the final analysis. Compared to the preoperative group, the average postoperative fastball usage rate was less despite there being an increase in the off-speed usage rate. Velocity analysis demonstrated shifts of less than 1% for all three pitch groups compared to preoperative velocity average values (all P-values <0.05). Earned Run Average (ERA)+demonstrates a decrease in the postoperative group; this finding was not significant (P=0.61). Patients treated surgically demonstrated a throwing tendency for theirsecondary and tertiary pitches and a decreased usage of fastballs. Further studies areneeded to explore the factors contributing to the change in pitching performance.

Ulnar Collateral Ligament Reconstruction in Female Javelin Athletes: A Case Series and Review of the Literature.

Ulnar Collateral Ligament Reconstruction in Female Javelin Athletes: A Case Series and Review of the Literature.

Patient-Reported and Clinical Outcomes After Tendon Autograft Reconstruction of the Thumb Ulnar Collateral Ligament

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.