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.

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 ( 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.

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

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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