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

ABSTRACT:

Background

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.

Questions/purposes

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

Methods

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.

Results

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%.

Conclusions

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.

SUBMITTER: Glogovac G

PROVIDER: S-EPMC7534884 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundInjury to the ulnar collateral ligament (UCL) leading to medial elbow instability and possible ulnar neuritis is common in overhead-throwing athletes. Treatment may require UCL reconstruction (UCLR) and concomitant ulnar nerve transposition (UNT) for those with preoperative ulnar neuritis.PurposeTo evaluate the return-to-play (RTP) rates, clinical outcomes, and rates of persistent ulnar neuritis after concomitant UCLR and UNT in a cohort of baseball players with confirmed preoperative ulnar neuritis.Study designCase series; Level of evidence, 4.MethodsEligible patients were those who underwent concomitant UCLR and UNT at a single institution between January 2008 and June 2018 and who had a minimum of 2 years of follow-up. Additional inclusion criteria were athletes who identified as baseball players and who had a confirmed history of ulnar neuritis. Patients were contacted at a minimum of 2 years from surgery and assessed with the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, Andrew-Timmerman (A-T) Elbow Score, Mayo Elbow Performance Score (MEPS), Single Assessment Numeric Evaluation (SANE) score, and a custom RTP questionnaire.ResultsIncluded were 22 male baseball players with a mean age of 18.9 ± 2.1 years (range, 16-25 years). The mean follow-up was 6.1 ± 2.4 years (range, 2.5-11.7 years). Preoperatively, all 22 patients reported ulnar nerve sensory symptoms, while 4 (18.2%) patients reported ulnar nerve motor symptoms. At the final follow-up, 7 (31.8%) patients reported persistent ulnar nerve sensory symptoms, while none of the patients reported persistent ulnar nerve motor symptoms. Overall, 16 (72.7%) players were able to return to competitive play at an average of 11.2 months. The mean postoperative patient-reported outcome scores for the KJOC Shoulder and Elbow Score, MEPS, A-T Elbow Score, and SANE score were 77.9 ± 20.9 (range, 14-100), 92.7 ± 12.7 (range, 45-100), 86.1 ± 17.1 (range, 30-100), and 85.5 ± 14.8 (range, 50-100), respectively.ConclusionThis study demonstrated that after concomitant UCLR and UNT for UCL insufficiency and associated ulnar neuritis, baseball players can expect reasonably high RTP rates and subjective outcomes; however, rates of persistent sensory ulnar neuritis can be as high as 30%.

Project description:IntroductionThe literature on the early reconstruction of severe acute lateral ligament injuries in professional athletes suggests earlier rehabilitation and reduced incidence of recurrent instability. Predicted time to return to training and sports is important to both the athlete and the club and has not previously been reported.Aims and objectivesThe primary aim was to establish the best treatment options available for lateral ligament injury in professional athletes and assess the average time to return to physical training and return to play (RTP). Secondary aims were to find out the rate of return to the pre-injury level of competitive sports and the reasons for delayed recovery.Materials and methodsWe performed a systematic review according to PRISMA guidelines to evaluate the demographics, clinical profile, management, and treatment outcomes. Electronic searches of the MEDLINE, EMBASE, and Cochrane databases were performed. Studies conducted between Jan 2000 and Dec 2020 with articles reporting the ankle lateral ligament reconstruction in professional athletes were included.Main resultsAfter initial screening, 982 articles were identified, of which, 10 articles evaluating 343 athletes met the criteria and were included for final review. The combined mean age was 23 years with an average follow-up of 58.4 months. After surgery 308 (89%) returned to their pre-injury level of sports, 7 (2%) patients returned to a lower-level sport while the remaining 28 (9%) never returned to play.ConclusionOur results provide a guide to predict the expected time to return to play (RTP) after surgical repair of lateral ligament injuries along with associated injuries leading to delayed rehabilitation. Lateral ligament reconstruction is a safe and effective treatment for severe ruptures providing a stable ankle with a mean time of 16 weeks to return to sports. The available studies vary considerably in their metrics used for measuring patient-reported outcomes.Supplementary informationThe online version contains supplementary material available at 10.1007/s43465-021-00532-0.