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Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 4/2019

01-12-2019 | Injuries in Overhead Athletes (J Dines and C Camp, Section Editors)

UCL Injury in the Non-throwing Athlete

Authors: Nicholas Ramos, Orr Limpisvasti

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2019

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Abstract

Purpose of Review

Primarily reported in the overhead throwing athlete, ulnar collateral ligament (UCL) injuries have been extensively studied since Dr. Frank Jobe first described his technique for ulnar collateral ligament reconstruction on professional baseball pitcher Tommy John. While the framework for our understanding of UCL injury was initially established studying the repetitive valgus loading of the throwers’ elbow, other sport-related activities in non-throwing athletes can impart similar valgus stress on the medial elbow placing the UCL at risk for injury. The purpose of this review is to evaluate the current literature on UCL injury specifically in the non-throwing athlete.

Recent Findings

In the four decades since Dr. Jobe’s seminal description of UCL reconstruction, an abundance of literature has been published on UCL injury in the throwing athlete. The evidence evaluating the UCL specifically in the non-throwing athlete, however, is quite scarce. Several small retrospective studies have demonstrated good results with high rates of return to play with focused rehabilitation and non-operative management in non-throwing athletes. Recent evidence has also demonstrated that surgical repair and/or reconstruction of the UCL in this population can produce good outcomes.

Summary

The level of evidence of these published studies is low and consists primarily of case series without control groups. Further investigation is warranted to determine the optimal treatment algorithm for UCL injury in the non-throwing athlete.
Literature
1.
Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am. 1986;68(8):1158–63.PubMed
2.
Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23(2):233–9.PubMed
3.
Camp CL, Conte S, D'Angelo J, Fealy SA. Epidemiology of ulnar collateral ligament reconstruction in major and minor league baseball pitchers: comprehensive report of 1429 cases. J Shoulder Elb Surg. 2018;27(5):871–8.
4.
Conte SA, Fleisig GS, Dines JS, Wilk KE, Aune KT, Patterson-Flynn N, et al. Prevalence of ulnar collateral ligament surgery in professional baseball players. Am J Sports Med. 2015;43(7):1764–9.PubMed
5.
Hodgins JL, Vitale M, Arons RR, Ahmad CS. Epidemiology of medial ulnar collateral ligament reconstruction: a 10-year study in New York State. Am J Sports Med. 2016;44(3):729–34.PubMed
6.
Dines JS, ElAttrache NS, Conway JE, Smith W, Ahmad CS. Clinical outcomes of the DANE TJ technique to treat ulnar collateral ligament insufficiency of the elbow. Am J Sports Med. 2007;35(12):2039–44.PubMed
7.
Cain EL, McGonigle O. Return to play following ulnar collateral ligament reconstruction. Clin Sports Med. 2016;35(4):577–95.PubMed
8.
Erickson BJ, Bach BR, Cohen MS, Bush-Joseph CA, Cole BJ, Verma NN, et al. Ulnar collateral ligament reconstruction: the rush experience. Orthop J Sports Med. 2016;4(1):2325967115626876.PubMedPubMedCentral
9.
Coughlin RP, Gohal C, Horner NS, Shanmugaraj A, Simunovic N, Cadet ER, et al. Return to play and in-game performance statistics among pitchers after ulnar collateral ligament reconstruction of the elbow: a systematic review. Am J Sports Med. 2019;47(8):2003–10.PubMed
10.
Mahure SA, Mollon B, Shamah SD, Kwon YW, Rokito AS. Disproportionate trends in ulnar collateral ligament reconstruction: projections through 2025 and a literature review. J Shoulder Elb Surg. 2016;25(6):1005–12.
11.
Erickson BJ, Harris JD, Tetreault M, Bush-Joseph C, Cohen M, Romeo AA. Is Tommy John surgery performed more frequently in Major League Baseball pitchers from warm weather areas? Orthop J Sports Med. 2014;2(10):2325967114553916.PubMedPubMedCentral
12.
Zaremski JL, Horodyski M, Donlan RM, Brisbane ST, Farmer KW. Does geographic location matter on the prevalence of ulnar collateral ligament reconstruction in collegiate baseball pitchers? Orthop J Sports Med. 2015;3(11):2325967115616582.PubMedPubMedCentral
13.
Kenter K, Behr CT, Warren RF, O'Brien SJ, Barnes R. Acute elbow injuries in the National Football League. J Shoulder Elb Surg. 2000;9(1):1–5.
14.
Frey A, Lambert C, Vesselle B, Rousseau R, Dor F, Marquet LA, et al. Epidemiology of judo-related injuries in 21 seasons of competitions in France: a prospective study of relevant traumatic injuries. Orthop J Sports Med. 2019;7(5):2325967119847470.PubMedPubMedCentral
15.
Scoggin JF, Brusovanik G, Izuka BH, Zandee van Rilland E, Geling O, Tokumura S. Assessment of injuries during Brazilian jiu-jitsu competition. Orthop J Sports Med. 2014;2(2):2325967114522184.PubMedPubMedCentral
16.
Zaremski JL, McClelland J, Vincent HK, Horodyski M. Trends in sports-related elbow ulnar collateral ligament injuries. Orthop J Sports Med. 2017;5(10):2325967117731296.PubMedPubMedCentral
17.
• Li NY, Goodman AD, Lemme NJ, Owens BD. Epidemiology of elbow ulnar collateral ligament injuries in throwing versus contact athletes of the National Collegiate Athletic Association: Analysis of the 2009–2010 to 2013–2014 Seasons. Orthop J Sports Med. 2019;7(4):2325967119836428 Query of the NCAA Injury Surveillance over 5 years across 25 varsity sports revealed the bulk of UCL injuries reported occurred in non-throwing (76.1%) versus throwing athletes (23.9%). UCL injuries in throwers, however, resulted in greater time loss from sport and a higher proportion of injuries in throwing athletes required surgical intervention as compared with non-throwers. PubMedPubMedCentral
18.
Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med. 1983;11(5):315–9.PubMed
19.
Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res. 1991;265:187–95.
20.
Callaway GH, Field LD, Deng XH, Torzilli PA, O'Brien SJ, Altchek DW, et al. Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone Joint Surg Am. 1997;79(8):1223–31.PubMed
21.
Alcid JG, Ahmad CS, Lee TQ. Elbow anatomy and structural biomechanics. Clin Sports Med. 2004;23(4):503–17 vii.PubMed
22.
Labott JR, Aibinder WR, Dines JS, Camp CL. Understanding the medial ulnar collateral ligament of the elbow: review of native ligament anatomy and function. World J Orthop. 2018;9(6):78–84.PubMedPubMedCentral
23.
Eygendaal D, Valstar ER, Söjbjerg JO, Rozing PM. Biomechanical evaluation of the elbow using roentgen stereophotogrammetric analysis. Clin Orthop Relat Res. 2002;396:100–5.
24.
Morrey BF, An KN. Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res. 1985;201:84–90.
25.
Regan WD, Korinek SL, Morrey BF, An KN. Biomechanical study of ligaments around the elbow joint. Clin Orthop Relat Res. 1991;271:170–9.
26.
Werner SL, Fleisig GS, Dillman CJ, Andrews JR. Biomechanics of the elbow during baseball pitching. J Orthop Sports Phys Ther. 1993;17(6):274–8.PubMed
27.
Koh TJ, Grabiner MD, Weiker GG. Technique and ground reaction forces in the back handspring. Am J Sports Med. 1992;20(1):61–6.PubMed
28.
Rettig AC, Sherrill C, Snead DS, Mendler JC, Mieling P. Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med. 2001;29(1):15–7.PubMed
29.
Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Return-to-play outcomes in professional baseball players after medial ulnar collateral ligament injuries: comparison of operative versus nonoperative treatment based on magnetic resonance imaging findings. Am J Sports Med. 2016;44(3):723–8.PubMed
30.
• Nicolette GW, Gravlee JR. Ulnar collateral ligament injuries of the elbow in female division I collegiate gymnasts: a report of five cases. Open Access J Sports Med. 2018;9:183–9 4 out 5 Division 1 gymnasts who sustained UCL injuries during gymnastic activities were able to return to the same level sport following a structured rehabilitation program at a mean of 3.98 weeks after injury. PubMedPubMedCentral
31.
• McCrum CL, Costello J, Onishi K, Stewart C, Vyas D. Return to play after PRP and rehabilitation of 3 elite ice hockey players with ulnar collateral ligament injuries of the elbow. Orthop J Sports Med. 2018;6(8):2325967118790760 Series of 3 professional hockey players with traumatic UCL injuries sustained in season. Following a structured rehabilitation protocol and two leukocyte poor PRP injections, 3/3 players were able to return to play at mean of 36 days following injury. PubMedPubMedCentral
32.
Donohue BF, Lubitz MG, Kremchek TE. Elbow ulnar collateral ligament reconstruction using the novel docking plus technique in 324 athletes. Sports Med Open. 2019;5(1):3.PubMedPubMedCentral
33.
Myeroff C, Brock JL, Huffman GR. Ulnar collateral ligament reconstruction in athletes using a cortical button suspension technique. J Shoulder Elb Surg. 2018;27(8):1366–72.
34.
Kodde IF, Rahusen FT, Eygendaal D. Long-term results after ulnar collateral ligament reconstruction of the elbow in European athletes with interference screw technique and triceps fascia autograft. J Shoulder Elb Surg. 2012;21(12):1656–63.
35.
Cain EL, Andrews JR, Dugas JR, Wilk KE, McMichael CS, Walter JC, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426–34.PubMed
36.
Rohrbough JT, Altchek DW, Hyman J, Williams RJ, Botts JD. Medial collateral ligament reconstruction of the elbow using the docking technique. Am J Sports Med. 2002;30(4):541–8.PubMed
37.
Thompson WH, Jobe FW, Yocum LA, Pink MM. Ulnar collateral ligament reconstruction in athletes: muscle-splitting approach without transposition of the ulnar nerve. J Shoulder Elb Surg. 2001;10(2):152–7.
38.
Azar FM, Andrews JR, Wilk KE, Groh D. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med. 2000;28(1):16–23.PubMed
39.
Jones KJ, Dines JS, Rebolledo BJ, Weeks KD, Williams RJ, Dines DM, et al. Operative management of ulnar collateral ligament insufficiency in adolescent athletes. Am J Sports Med. 2014;42(1):117–21.PubMed
40.
• Fuller JB, Dunn JC, Kusnezov NA, Nesti LJ, Kilcoyne KG. Outcome measures after medial ulnar collateral ligament reconstructions in a military population. J Shoulder Elb Surg. 2019;28(2):317–23 66 active duty military members underwent UCL reconstruction for persistently symptomatic UCL insufficiency. At final follow up, 86.4% of patients reported no significant elbow disability and only 13.6 perecent of patients were no longer active duty military specifically due to their elbow. Although 36.4% of patients reported a throwing mechanism of injury and 47% of the cohort reported a history of throwing sports, this represents the largest series of UCL reconstruction outcomes in a predominantly non-throwing population.
41.
Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74(1):67–83.PubMed
42.
Moore AR, Fleisig GS, Dugas JR. Ulnar collateral ligament repair. Orthop Clin N Am. 2019;50(3):383–9.
43.
Savoie FH, Trenhaile SW, Roberts J, Field LD, Ramsey JR. Primary repair of ulnar collateral ligament injuries of the elbow in young athletes: a case series of injuries to the proximal and distal ends of the ligament. Am J Sports Med. 2008;36(6):1066–72.PubMed
44.
Richard MJ, Aldridge JM, Wiesler ER, Ruch DS. Traumatic valgus instability of the elbow: pathoanatomy and results of direct repair. J Bone Joint Surg Am. 2008;90(11):2416–22.PubMed
45.
Kim NR, Moon SG, Ko SM, Moon WJ, Choi JW, Park JY. MR imaging of ulnar collateral ligament injury in baseball players: value for predicting rehabilitation outcome. Eur J Radiol. 2011;80(3):e422–6.PubMed
46.
Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma. Am J Sports Med. 2013;41(7):1689–94.PubMed
47.
Deal JB, Smith E, Heard W, O'Brien MJ, Savoie FH. Platelet-rich plasma for primary treatment of partial ulnar collateral ligament tears: MRI correlation with results. Orthop J Sports Med. 2017;5(11):2325967117738238.PubMedPubMedCentral
48.
Dines JS, Williams PN, ElAttrache N, Conte S, Tomczyk T, Osbahr DC, et al. Platelet-rich plasma can be used to successfully treat elbow ulnar collateral ligament insufficiency in high-level throwers. Am J Orthop (Belle Mead NJ). 2016;45(5):296–300.
49.
Argo D, Trenhaile SW, Savoie FH, Field LD. Operative treatment of ulnar collateral ligament insufficiency of the elbow in female athletes. Am J Sports Med. 2006;34(3):431–7.PubMed
50.
Makhni EC, Lee RW, Morrow ZS, Gualtieri AP, Gorroochurn P, Ahmad CS. Performance, return to competition, and reinjury after Tommy John surgery in Major League Baseball pitchers: a review of 147 cases. Am J Sports Med. 2014;42(6):1323–32.PubMed
51.
Erickson BJ, Gupta AK, Harris JD, Bush-Joseph C, Bach BR, Abrams GD, et al. Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers. Am J Sports Med. 2014;42(3):536–43.PubMed
Metadata
Title
UCL Injury in the Non-throwing Athlete
Authors
Nicholas Ramos
Orr Limpisvasti
Publication date
01-12-2019
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 4/2019
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-019-09590-2

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