Baseball players who need ulnar collateral ligament (UCL) revision reconstruction might not be able to return to the game, according to a new study.
Return to Play After UCL Revision Not as Promising
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In the article, “Outcomes After Ulnar Collateral Ligament Revision Reconstruction in Baseball Players,” published online October 21, 2020 in The American Journal of Sports Medicine. The researchers evaluated return to play and patient outcomes after ulnar collateral ligament (UCL) revision reconstruction.
The study included 65 consecutive baseball players who needed the revision because of a retear of the ligament or pain. All surgeries were done between June 2004 and July 2016 at two surgical centers. Most of the athletes were pitchers.
All patient charts were reviewed for age, sex, date of primary and revision reconstruction, sport played, level of play, graft type, and complications. All the patients were contacted by telephone to determine return to play, current level of participation, Conway score, Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, and satisfaction.
Overall, time to return to throwing was 6.2 ± 2.3 months (mean ± SDL), and the KJOC score was 74.2 ± 20.7. About 50% received an excellent Conway Score, which indicates a return to previous competition level for at least 1 year. Thirty percent had a good score, indicating a return to a lower level for at least 1 year.
It generally took 12.7 ± 3.6 months for those that did play again to return. Forty-seven percent of pitchers returned to the previous competition levels for at least 1 year with a KJOC score of 73.7 ± 21.1. Pitchers were able to return to throwing at 6.3±2.3 months and competitions at 12.8±3.7 months.
The researchers wrote, “There is a lack of evidence regarding the success of ulnar collateral ligament (UCL) revision reconstruction. Understanding outcomes after UCL revision reconstruction is important in clinical decision making for overhead athletes.”
They added, “Only half of baseball players undergoing UCL revision reconstruction were able to return to the previous levels of competition. Outcomes for revision reconstruction are not as promising as primary procedures. Baseball players should be cautioned that they may not return to their previous levels of play after a revision reconstruction.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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