ABSTRACT
Shoulder and elbow injuries have been described in baseball players as early as the 1940s. Ulnar collateral ligament (UCL) tears have been recognized as a significant source of disability for baseball players and have been seen in increasing frequency as training regimens and level of play have become more intense and rigorous. Our understanding and treatment of these injuries have also evolved over time. This article summarizes the evolution of the treatment of UCL tears and discusses future directions for the treatment and prevention of these injuries.
Subject(s)
Arm Injuries/surgery , Baseball/injuries , Collateral Ligament, Ulnar/surgery , Elbow Joint/surgery , Ulnar Collateral Ligament Reconstruction , Arm Injuries/diagnostic imaging , Arm Injuries/etiology , Arm Injuries/physiopathology , Biomechanical Phenomena , Collateral Ligament, Ulnar/diagnostic imaging , Collateral Ligament, Ulnar/injuries , Collateral Ligament, Ulnar/physiopathology , Diffusion of Innovation , Elbow Joint/diagnostic imaging , Elbow Joint/physiopathology , Forecasting , History, 20th Century , History, 21st Century , Humans , Recovery of Function , Time Factors , Treatment Outcome , Ulnar Collateral Ligament Reconstruction/adverse effects , Ulnar Collateral Ligament Reconstruction/history , Ulnar Collateral Ligament Reconstruction/trends , Elbow InjuriesABSTRACT
INTRODUCTION: Ulnar collateral ligament (UCL) reconstructions are being performed with an increasing annual incidence. The purpose of this study was to evaluate trends in UCL surgery among recently trained orthopaedic surgeons. METHODS: The American Board of Orthopaedic Surgeons (ABOS) database was used to identify all UCL reconstructions from 2004 to 2013. Procedures were identified by Current Procedural Terminology (CPT) codes and verified by International Classification of Disease, Ninth Revision (ICD-9) codes. Data on surgeon fellowship, practice location, concomitant surgical procedures, and complications were collected. RESULTS: One hundred sixty-four UCL reconstructions were performed by 133 ABOS Part II candidates. The annual incidence increased from 1.52 to 3.46 cases per 10,000 (P = 0.042). Reconstructions were most commonly performed by surgeons with fellowship training in sports medicine (65.9%), hand and upper extremity (18.9%), and shoulder and elbow (9.1%). Most reconstructions were performed in isolation (57.3%), or with ulnar nerve transposition (32.9%) or elbow arthroscopy (9.8%). Concomitant elbow arthroscopy rates decreased significantly (P = 0.022). Complications occurred in 9.8% of cases, although the rates did not significantly change (P = 0.466). CONCLUSIONS: UCL reconstructions are being performed with increasing frequency. Concomitant procedure rates remained the same, although arthroscopy was less commonly performed. Complication rates did not change considerably over the observed period. Further study of the surgical trends and associated long-term outcomes is warranted. LEVEL OF EVIDENCE: Level IV.
