Trends in Medial Ulnar Collateral Ligament Reconstruction in the United Sates: A retrospective review of a large private-payer database from 2007 to 2011
Erickson BJ, Nwachukwu BU, Rosas S, Schairer WW, McCormick FM, Bach BR, Bush-Joseph CA, Romeo AA. American Journal of Sports Medicine. 43:1770-1774.
Take Home Message: High school athletes are having ulnar collateral reconstruction at an exponential rate annually.
When Tommy John surgery was first introduced back in 1986, it was a breakthrough, which allowed throwing athletes (pitchers) to return to play at the elite level. Since then, both professional and amateur baseball pitchers have successfully returned to playing high-level baseball. Surprisingly, even high school pitchers are currently undergoing ulnar collateral ligament reconstruction (UCLR) on a regular basis. However, the rate at which this is occurring is unknown. Therefore, Erickson et al conducted a retrospective database (private payer) analysis to identify UCLR procedures performed between 2007-2011 and to determine the rate of increase. The authors further divided patients by age, geographic location, and time of year. The authors found that 790 patients underwent UCLR between 2007-2011. The majority of patients were 15-19 years of age followed by those between 20-24 year of age. The region of the United States that had the most UCLR procedures was the South. Most of the UCLR procedures were performed in the 2nd quarter of a year (between April-June).
The increased incidence of UCLR among teenagers creates a deliberation of reasons. Similar to the increased awareness of concussions within the last 10-15 years, the general athletic population has increased perception of the ulnar collateral ligament due to the increased incidence of UCLR in Major League Baseball and collegiate baseball pitchers. Alongside public perception, the authors reviewed an article where a survey was issued to high school and college baseball players, parents, and coaches regarding their perception of UCLR as it related to risks, recovery time, operative technique, and benefits. One of the interesting outcomes of the questionnaire was that a significant amount of responses displayed the perception that UCLR should be performed prophylactically. High school athletes, parents, and coaches believe that UCLR will actually improve performance. Interestingly, a recent study found that only 82% of patients return to pre-injury levels of performance and there was no change in velocity (http://www.ncbi.nlm.nih.gov/pubmed/24496506). Clinicians should educate athletes and parents about the outcomes following UCLR. The authors noted various limitations associated with accessing private payer databases. These limitations include possible bias among patient populations and errors related to coding or erroneous code entry of CPT codes. Interestingly, the article did not identify if patients underwent revision UCLR procedures.
Questions for Discussion: What are some avenues to address injury risk reduction efforts in the 15-19 year old population? What are some speculations for the South having the highest incidence of UCLR?
Written By: Sheena Long
Reviewed by: Stephen Thomas
Related Posts:Injuries in High School Softball and Baseball Players
Erickson, B., Nwachukwu, B., Rosas, S., Schairer, W., McCormick, F., Bach, B., Bush-Joseph, C., & Romeo, A. (2015). 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, 43 (7), 1770-1774 DOI: 10.1177/0363546515580304