ABSTRACT
PURPOSE
The purpose of this study was to establish consensus statements on the treatment of
UCL injuries and to investigate whether consensus on these distinct topics could be
reached.
METHODS
A modified consensus technique was conducted among twenty-six elbow surgeons and 3
physical therapists/athletic trainers. Strong consensus was defined as 90-99% agreement.
RESULTS
Of the 19 total questions and consensus statements 4 achieved unanimous consensus,
13 achieved strong consensus, and 2 did not achieve consensus.
CONCLUSION
There was unanimous agreement that the risk factors include overuse, high velocity,
poor mechanics, and prior injury. There was unanimous agreement that advanced imaging
in the form of either an MRI or MRA should be performed in a patient presenting with
suspected/known UCL tear that plans to continue to play an overhead sport, or if the
imaging study could change the management of the patient. There was unanimous agreement
regarding lack of evidence for the use of orthobiologics in the treatment of UCL tears
as well as the areas pitchers should focus on when attempting a course of non-operative
management. The statements that reached unanimous agreement for operative management
were regarding operative indications and contraindications for UCL tears, prognostic
factors that should be taken into consideration in when performing UCL surgery, how
to deal with the flexor-pronator mass during UCL surgery and use of an internal brace
with UCL repairs. Statements that reached unanimous agreement for RTS were regarding:
portions of the physical exam should be considered when determining whether to allow
a player to RTS, unclear how velocity, accuracy, and spin rate should be factored
into the decision of when players can RTS and sports psychology testing should be
used to determine whether a player is ready to RTS. Level of Evidence: Expert opinion (Level V)
Keywords
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REFERENCES
- Elbow Ulnar Collateral Ligament Injuries: Indications, Management, and Outcomes.Arthroscopy. 2020; 36: 1221-1222
- Ulnar Collateral Ligament Injuries of the Elbow in the Throwing Athlete.JBJS Rev. 2018; 6: e1
- Ulnar collateral ligament injury in the overhead athlete: diagnosis and treatment.Clin Sports Med. 2004; 23 (x): 643-663
- Trends in Medial Ulnar Collateral Ligament Reconstruction in the United States: A Retrospective Review of a Large Private-Payer Database From 2007 to 2011.The American journal of sports medicine. 2015; 43: 1770-1774
- Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers.Am J Sports Med. 2014; 42: 536-543
- Summative Report on Time Out of Play for Major and Minor League Baseball: An Analysis of 49,955 Injuries From 2011 Through 2016.The American journal of sports medicine. 2018; 46: 1727-1732
- The Middle and Distal Aspects of the Ulnar Footprint of the Medial Ulnar Collateral Ligament of the Elbow Do Not Provide Significant Resistance to Valgus Stress: A Biomechanical Study.Orthop J Sports Med. 2019; 72325967118825294
- Anatomy of the anterior bundle of the ulnar collateral ligament.J Shoulder Elbow Surg. 2007; 16: 657-660
- Kinetics of baseball pitching with implications about injury mechanisms.The American journal of sports medicine. 1995; 23: 233-239
- Biomechanics of the elbow during baseball pitching.The Journal of orthopaedic and sports physical therapy. 1993; 17: 274-278
- Fastball Pitch Velocity Helps Predict Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.Am J Sports Med. 2016; 44: 2130-2135
- Musculoskeletal ultrasound: elbow imaging and procedures.Semin Musculoskelet Radiol. 2010; 14: 449-460
- Prognostic utility of an magnetic resonance imaging-based classification for operative versus nonoperative management of ulnar collateral ligament tears: one-year follow-up.J Shoulder Elbow Surg. 2019; 28: 1159-1165
- Clinical Utility of an MRI-Based Classification System for Operative Versus Nonoperative Management of Ulnar Collateral Ligament Tears: A 2-Year Follow-up Study.Orthop J Sports Med. 2019; 72325967119839785
- Ulnar Collateral Ligament Tear Location May Affect Return-to-Sports Rate but Not Performance Upon Return to Sports After Ulnar Collateral Ligament Reconstruction Surgery in Professional Baseball Players.Am J Sports Med. 2020; 48: 2608-2612
- Ulnar Collateral Ligament Repair With Collagen-Dipped FiberTape Augmentation in Overhead-Throwing Athletes.The American journal of sports medicine. 2019; 47: 1096-1102
- Decision making in treatment after a first-time anterior glenohumeral dislocation: A Delphi approach by the Neer Circle of the American Shoulder and Elbow Surgeons.J Shoulder Elbow Surg. 2020; 29: 2429-2445
- Editorial. Foot Ankle Int. 2018; 39: 1S-2S
- Editorial Commentary: Degenerative Meniscal Tear: Sojourn to the Oracle.Arthroscopy. 2020; 36: 513-515
- Degenerative Meniscus Lesions: An Expert Consensus Statement Using the Modified Delphi Technique.Arthroscopy. 2020; 36: 501-512
- Expert Consensus Based Evidence Using the Delphi Method.Arthroscopy. 2018; 34: 3278-3282
- Metric Development for an Arthroscopic Bankart Procedure: Assessment of Face and Content Validity.Arthroscopy. 2015; 31: 1430-1440
- Defining massive rotator cuff tears: a Delphi consensus study.J Shoulder Elbow Surg. 2020; 29: 674-680
- Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: the definition of periprosthetic shoulder infection.J Shoulder Elbow Surg. 2019; 28: S8-S12
- The REDCap consortium: Building an international community of software platform partners.J Biomed Inform. 2019; 95103208
Chalmers PN, Sgroi T, Riff AJ, et al. Correlates With History of Injury in Youth and Adolescent Pitchers. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2015;31:1349-1357.
- The Impact of Fatigue on Baseball Pitching Mechanics in Adolescent Male Pitchers.Arthroscopy. 2016; 32: 762-771
- Prevention of elbow injuries in youth baseball pitchers.Sports health. 2012; 4: 419-424
- Risk of serious injury for young baseball pitchers: a 10-year prospective study.The American journal of sports medicine. 2011; 39: 253-257
- Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up.The American journal of sports medicine. 2010; 38: 2426-2434
- Ulnar Collateral Ligament Reconstruction: The Rush Experience.Orthop J Sports Med. 2016; 42325967115626876
- The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review.The American journal of sports medicine. 2008; 36: 1193-1205
- Biomechanical Comparison of Ulnar Collateral Ligament Repair With Internal Bracing Versus Modified Jobe Reconstruction.Am J Sports Med. 2016; 44: 735-741
- 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.The American journal of sports medicine. 2008; 36: 1066-1072
- Stress sonography of the ulnar collateral ligament of the elbow in professional baseball pitchers: a 10-year study.The American journal of sports medicine. 2014; 42: 544-551
- Diagnostic Imaging of Ulnar Collateral Ligament Injury: A Systematic Review.Am J Sports Med. 2020; 48: 2819-2827
- Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study.The American journal of sports medicine. 2014; 42: 2075-2081
- 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.The American journal of sports medicine. 2016; 44: 723-728
- Magnetic Resonance Imaging Predictors of Failure in the Nonoperative Management of Ulnar Collateral Ligament Injuries in Professional Baseball Pitchers.The American journal of sports medicine. 2017; 363546517699832
- Platelet-Rich Plasma Can Be Used to Successfully Treat Elbow Ulnar Collateral Ligament Insufficiency in High-Level Throwers.American journal of orthopedics. 2016; 45: 296-300
- Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma.The American journal of sports medicine. 2013; 41: 1689-1694
- Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries With and Without Platelet-Rich Plasma in Professional Baseball Players: A Comparative and Matched Cohort Analysis.The American journal of sports medicine. 2019; 47: 3107-3119
- Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study.British journal of sports medicine. 2016; 50: 804-808
- Return to Sport Participation Criteria Following Shoulder Injury: A Clinical Commentary.International journal of sports physical therapy. 2020; 15: 624-642
- Timing of Return to Batting Milestones After Ulnar Collateral Ligament Reconstruction in Professional Baseball Players.Am J Sports Med. 2020; 48: 1465-1470
Erickson BJ, Chalmers PN, Bach BR, Jr., et al. Length of time between surgery and return to sport after ulnar collateral ligament reconstruction in Major League Baseball pitchers does not predict need for revision surgery. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]. 2017;26:699-703.
- Do Major League Baseball Team Physicians Harvest the Semitendinosus From the Drive Leg or Landing Leg When Performing Ulnar Collateral Ligament Reconstruction on Elite Baseball Pitchers?.Orthop J Sports Med. 2017; 52325967117713987
- Ulnar Collateral Ligament Reconstruction of the Elbow: A Systematic Review of the Literature.Orthop J Sports Med. 2015; 32325967115618914
- Do Outcomes or Subsequent Injuries Differ After Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Autograft?.The American journal of sports medicine. 2019; 47: 1473-1479
- Are the hamstrings from the drive leg or landing leg more active in baseball pitchers? An electromyographic study.J Shoulder Elbow Surg. 2017; 26: 2010-2016
- Side of Hamstring Harvest Does Not Affect Performance, Return-to-Sport Rate, or Future Hamstring Injuries After Ulnar Collateral Ligament Reconstruction Among Professional Baseball Pitchers.The American journal of sports medicine. 2019; 47: 1111-1116
- Ulnar Collateral Ligament Reconstruction in Adolescents: A Systematic Review.Am J Sports Med. 2021; 49: 1355-1362
- Repair of the Ulnar Collateral Ligament of the Elbow: Rehabilitation Following Internal Brace Surgery.The Journal of orthopaedic and sports physical therapy. 2019; 49: 253-261
Camp CL, Conte S, D'Angelo J, Fealy SA. Following ulnar collateral ligament reconstruction, professional baseball position players return to play faster than pitchers, but catchers return less frequently. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]. 2018;27:1078-1085.
- Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers.The American journal of sports medicine. 2019; 47: 1103-1110
- Rate of Return to Pitching and Performance After Tommy John Surgery in Major League Baseball Pitchers.The American journal of sports medicine. 2013;
- Ulnar collateral ligament reconstruction in major league baseball pitchers.The American journal of sports medicine. 2007; 35: 575-581
Liu JN, Garcia GH, Conte S, ElAttrache N, Altchek DW, Dines JS. Outcomes in revision Tommy John surgery in Major League Baseball pitchers. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]. 2016;25:90-97.
- Timing of Return to Batting Milestones After Ulnar Collateral Ligament Reconstruction in Professional Baseball Players.The American journal of sports medicine. 2020; 363546520910417
- Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport.Am J Sports Med. 2010; 38: 1968-1978
- Dynamic function after anterior cruciate ligament reconstruction with autologous patellar tendon.Am J Sports Med. 2001; 29: 36-41
- Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training.Am J Sports Med. 2021; 49: 417-425
- Expert Opinion Is Necessary: Delphi Panel Methodology Facilitates a Scientific Approach to Consensus.Arthroscopy. 2018; 34: 349-351
Article info
Publication history
Accepted:
December 29,
2022
Received in revised form:
December 8,
2022
Received:
November 24,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
The Ulnar Collateral Ligament – Delphi Consensus Group (UCL-DCG) includes
Salvatore Frangiamore MD, Joshua S. Dines MD, Michael G. Ciccotti MD, Felix H. Savoie, MD, Michael J. O’Brien MD, E Lyle Cain MD, Gregory L. Cvetanovich MD, Mark S. Cohen, MD, Nikhil N. Verma MD, Hiroyuki Sugaya, MD, Eric C. Makhni MD, David W. Altchek MD, Peter N. Chalmers MD, Christopher S. Ahmad MD, Mark S. Schickendantz, MD, Anthony A. Romeo MD, Jeffrey R. Dugas MD, George A. Paletta MD, Michael M. Reinold DPT, ATC, C-PS, Stan Conte PT, DPT, ATC, Kevin E Wilk, DPT, FAPTA, Steven B. Cohen MD, Charles A. Bush-Joseph MD, Thomas K. Noonan MD, Christopher L. Camp MD, Jan Fronek MD
Identification
Copyright
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