UCL Injury in the Non-throwing Athlete
- 28 Downloads
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.
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.
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.
KeywordsUlnar collateral ligament injury Non-throwing athlete Non-operative treatment Ulnar collateral ligament repair Ulnar collateral ligament reconstruction
Compliance with Ethical Standards
Conflict of Interest
Nicholas Ramos and Orr Limpisvasti declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 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.PubMedCrossRefPubMedCentralGoogle Scholar
- 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. PubMedPubMedCentralCrossRefGoogle Scholar
- 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.Google Scholar
- 24.Morrey BF, An KN. Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res. 1985;201:84–90.Google Scholar
- 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.Google Scholar
- 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.PubMedCrossRefPubMedCentralGoogle Scholar
- 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. PubMedPubMedCentralCrossRefGoogle Scholar
- 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. PubMedPubMedCentralCrossRefGoogle Scholar
- 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. CrossRefGoogle Scholar
- 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.Google Scholar