Return to Sport and Sports-Specific Outcomes Following Ulnar Collateral Ligament Reconstruction in Adolescent Athletes: A Systematic Review

  • Georgina GlogovacEmail author
  • Rafael Kakazu
  • Alexander Constantine Aretakis
  • Brian M. Grawe
Review Article



The incidence of elbow injuries and ulnar collateral ligament (UCL) reconstruction in adolescent athletes is increasing. Knowledge and expectations of outcomes following this procedure are necessary for proper counseling and decision-making in this age group.


We sought to report patient-reported outcomes, rate of return to sport, and rate of complications and reoperation following UCL reconstruction in adolescent athletes.


A systematic review was conducted for adolescent athletes undergoing UCL reconstruction. The primary outcome measure was patient-reported outcome scores, specifically the Conway Scale, the Andrews-Timmerman score, and the Kerlan-Jobe Orthopaedic Clinic (KJOC) score. Secondary outcome measures included return to sport, rate of subsequent procedures, and complication rate. A descriptive analysis was performed.


Seven studies met the inclusion criteria. The average patient-reported outcome scores ranged from 81 to 87% (Conway, “excellent”), 83.6 to 92.7 (Andrews-Timmerman), and 76 to 89.3 (KJOC). The average rates of return to sport were 84% to preinjury level or higher, 93% to any level, and 57% to a higher level. Complication rates ranged from 0.7 to 11%. Rate of subsequent elbow procedures ranged from 0 to 10%.


This systematic review demonstrates favorable outcomes in adolescent athletes following UCL reconstruction. Patient-reported outcome scores and rates of return to sport were comparable with those reported in adult athletes. The procedure is not without risk of complications, and patients and parents should be counseled regarding this risk prior to surgery.


adolescent baseball pitching ulnar collateral ligament reconstruction 


Compliance with Ethical Standards

Conflict of Interest

Georgina Glogovac, MD, Rafael Kakazu, MD, Alexander Constantine Aretakis, BA, and Brian M. Grawe, MD, declare that they have no conflicts of interest.

Human/Animal Rights


Informed Consent


Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

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  1. 1.
    Abdul-Rassoul H, Galvin JW, Curry EJ, Simon J, Li X Return to sport after surgical treatment for anterior shoulder instability: a systematic review. Am J Sports Med. 2018;363546518780934.Google Scholar
  2. 2.
    Ahmad CS, Padaki AS, Noticewala MS, Makhni EC, Popkin CA The Youth Throwing Score: validating injury assessment in young Baseball Players. Am J Sports Med. 2017;45:317–324.CrossRefGoogle Scholar
  3. 3.
    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;28:16–23.CrossRefGoogle Scholar
  4. 4.
    Bruce JR, Andrews JR Ulnar collateral ligament injuries in the throwing athlete. J Am Acad Orthop Surg. 2014;22:315–325.CrossRefGoogle Scholar
  5. 5.
    Cain EL, Andrews JR, Dugas JR, 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;38:2426–2434.CrossRefGoogle Scholar
  6. 6.
    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;74:67–83.CrossRefGoogle Scholar
  7. 7.
    DeWitt EM, Stucky BD, Thissen D, et al. Construction of the eight-item patient-reported outcomes measurement information system pediatric physical function scales: built using item response theory. J Clin Epidemiol. 2011;64:794–804.CrossRefGoogle Scholar
  8. 8.
    Erickson BJ, Bach BR, Cohen MS, et al. Ulnar collateral ligament reconstruction: the rush experience. Orthop J Sports Med. 2016;4:2325967115626876Google Scholar
  9. 9.
    Erickson BJ, Chalmers PN, Bush-Joseph CA, Verma NN, Romeo AA. Ulnar collateral ligament reconstruction of the elbow: a systematic review of the literature. Orthop J Sports Med. 2015;3:2325967115618914Google Scholar
  10. 10.
    Erickson BJ, Gupta AK, Harris JD, et al. Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers. Am J Sports Med. 2014;42:536–543.CrossRefGoogle Scholar
  11. 11.
    Fleisig GS, Andrews JR. Prevention of elbow injuries in youth baseball pitchers. Sports Health. 2012;4:419–424.CrossRefGoogle Scholar
  12. 12.
    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;44:723–728.CrossRefGoogle Scholar
  13. 13.
    Heyworth B, Cohen L, von Heideken J, Kocher MS, Iversen MD. Validity and comprehensibility of outcome measures in children with shoulder and elbow disorders: creation of a new Pediatric and Adolescent Shoulder and Elbow Survey (Pedi-ASES). J Shoulder Elbow Surg. 2018;27:1162–1171.CrossRefGoogle Scholar
  14. 14.
    Jones KJ, Dines JS, Rebolledo BJ, Weeks KD, Williams RJ, Dines DM, Altchek DW. Operative management of ulnar collateral ligament insufficiency in adolescent athletes. Am J Sports Med. 2014;42:117–121.CrossRefGoogle Scholar
  15. 15.
    Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30:463–468.CrossRefGoogle Scholar
  16. 16.
    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 Elbow Surg. 2016;25:1005–1012.CrossRefGoogle Scholar
  17. 17.
    NCAA. Estimated probability of competing in professional athletics. 2015. Available from
  18. 18.
    O’Brien DF, O’Hagan T, Stewart R, Atanda AW, Hammoud S, Cohen SB, Ciccotti MG. Outcomes for ulnar collateral ligament reconstruction: a retrospective review using the KJOC assessment score with two-year follow-up in an overhead throwing population. J Shoulder Elbow Surg. 2015;24:934–940.CrossRefGoogle Scholar
  19. 19.
    Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34:905–912.CrossRefGoogle Scholar
  20. 20.
    Osbahr DC, Cain EL, Raines BT, Fortenbaugh D, Dugas JR, Andrews JR. Long-term outcomes after ulnar collateral ligament reconstruction in competitive baseball players: minimum 10-year follow-up. Am J Sports Med. 2014;42:1333–1342.CrossRefGoogle Scholar
  21. 21.
    Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. Am J Sports Med. 2004;32:1158–1164.CrossRefGoogle Scholar
  22. 22.
    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;29:15–17.CrossRefGoogle Scholar
  23. 23.
    Rice SG, Congeni JA, Council on Sports Medicine and Fitness. Baseball and softball. Pediatrics. 2012;129:842–856.CrossRefGoogle Scholar
  24. 24.
    Saper M, Shung J, Pearce S, Bompadre V, Andrews JR. Outcomes and return to sport after ulnar collateral ligament reconstruction in adolescent baseball players. Orthop J Sports Med. 2018;6:2325967118769328.Google Scholar
  25. 25.
    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;36:1066–1072.CrossRefGoogle Scholar
  26. 26.
    Somerson JS, Petersen JP, Neradilek MB, Cizik AM, Gee AO. Complications and outcomes after medial ulnar collateral ligament reconstruction: a meta-regression and systematic review. JBJS Rev. 2018;6:e4.Google Scholar

Copyright information

© Hospital for Special Surgery 2019

Authors and Affiliations

  1. 1.Department of Orthopaedics and Sports MedicineUniversity of CincinnatiCincinnatiUSA

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