Ulnar collateral ligament reconstruction in major league baseball pitchers

BACKGROUND: Ulnar collateral ligament reconstruction is commonly performed in major league pitchers, but little is known about pitching performance after a return to major league play. HYPOTHESIS: Pitching performance after ulnar collateral ligament reconstruction returns to baseline by the second season after surgery. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: Data were reviewed for 68 major league pitchers who pitched in at least 1 major league game before undergoing ulnar collateral ligament reconstruction between 1998 and 2003. Mean innings pitched per season, earned run average, and walks and hits per inning pitched were compared for each major league pitcher before and after surgery. All demographic and performance variables were analyzed for an association with ulnar collateral ligament insufficiency and a successful return to major league play. RESULTS: Fifty-six (82%) pitchers returned to major league play at a mean of 18.5 months after surgery with no significant change in mean earned run average or walks and hits per inning pitched. The mean innings pitched per season was not statistically different from controls by the second season after surgery. Starting pitchers demonstrated a higher risk of ulnar collateral ligament injury requiring reconstruction. More experienced pitchers and those with a higher earned run average were less likely to require ulnar collateral ligament reconstruction. No factors predictive of a successful return to play were identified. CONCLUSION: Most major league pitchers return from ulnar collateral ligament reconstruction by the second season after surgery with no statistical change in mean innings pitched, earned run average, or walks and hits per inning pitched from preinjury levels.     

Ulnar collateral ligament injury in baseball pitchers: MR imaging evaluation.

The ulnar collateral ligament (UCL) provides stability to the medial aspect of the elbow during valgus stress. Trauma to this ligament may result from repetitive forceful throwing. Diagnosis of UCL injury has been based on clinical findings of medial joint pain and valgus instability, as direct imaging of this structure has not been available. Eleven baseball pitchers with clinical evidence of UCL injury were evaluated with magnetic resonance (MR) imaging. Surgical correlation was obtained in six patients, four of whom underwent UCL reconstruction. MR imaging findings in UCL injury included laxity, irregularity, poor definition, and increased signal intensity within and adjacent to the UCL. These findings reflect the presence of hemorrhage and/or edema within the UCL due to repeated microtears, which eventually lead to weakening and possible disruption of the UCL. Optimization of spatial resolution, signal-to-noise ratio, and other technical factors is critical for evaluation of the UCL due to its small size. MR imaging is useful in documenting the presence and severity of injury to the UCL and in distinguishing this entity from other causes of elbow pain.     

MR imaging of ulnar collateral ligament injury in baseball players: value for predicting rehabilitation outcome

Background

To compare the MR findings of the ulnar collateral ligament (UCL) injury in baseball players between rehabilitation and reconstruction surgery.

Materials and methods

Thirty nine baseball players with clinical evidence of a UCL injury based on medial elbow pain and valgus instability were included. All patients received the rehabilitation treatment for more than six weeks. The elbow MR images of 27 patients not responding to rehabilitation treatment were reviewed that consequently had reconstruction surgery; in addition to 12 patients with improved symptoms with only rehabilitation treatment. The MR imaging was compared between the two treatment groups using the Pearson's chi-square test, and linear-by-linear association for the following features: the degree, signal intensity and site of the UCL injury on fat suppressed T2-weighted images.

Results

High-grade partial tears and complete tears were more commonly seen in the group that had surgery (14 out of 27 patients, 52%; 8 out of 27 patients, 30%), and low-grade partial tears and intact continuity were more common in the group that had rehabilitation only (5 out of 12 patients, 42%; 5 out of 12 patients, 42%) (p = 0.001). The injured UCL showed a fluid-like bright high or intermediate high signal intensity in the group that had surgery more frequently (14 out of 27 patients, 52%; 12 out of 27 patients, 44%), and intermediate high or low signal intensity was more frequent in the rehabilitation group (7 out of 12 patients, 58%; 3 out of 12 patients, 25%) (p = 0.013). The UCL injury at the origin site was most commonly seen in both groups (23 out of 27 patients, 85%; 11 out of 12 patients, 92%, respectively) (p = 0.496).

Conclusion

Preoperative MR imaging is useful for predicting the rehabilitation outcome of UCL injuries in baseball players.     

Ulnar collateral ligament injury in the overhead athlete

The ulnar collateral ligament (UCL), particularly the anterior portion of the anterior oblique ligament, is the primary static contributor to elbow valgus stability. UCL injuries are most common in athletes participating in overhead sports. Acute and chronic injuries to the UCL result in valgus instability, which may predispose the athlete to the development of disabling secondary elbow conditions. Provocative physical examination maneuvers include the valgus abduction test, the modified milking maneuver, and the moving valgus stress test. Plain radiographs and magnetic resonance imaging are the most common imaging modalities, although ultrasonography and computed tomography arthrograms can alternatively be used. UCL injuries can be treated initially with rest, anti-inflammatory medications, bracing, and/or physical therapy. Acute avulsion injuries can be repaired, especially in those under 20 years of age, but most UCL tears are now treated with reconstruction. Modifications of the Jobe figure-of-8 technique, and now the Altchek docking technique, are the most common reconstruction techniques. Many new and hybrid techniques have been described with limited clinical experience in the literature. Current techniques offer the athlete a greater than 90% chance of return to play at their preinjury level.     

Catastrophic injuries in high school and college baseball players

BACKGROUND: There are few epidemiologic studies of catastrophic baseball injuries. PURPOSE: To develop a profile of catastrophic injuries in baseball players and to describe relevant risk factors. STUDY DESIGN: Retrospective cohort study. METHODS: The authors reviewed 41 incidents of baseball injuries reported to the National Center for Catastrophic Sports Injury Research from 1982 until 2002. RESULTS: There were an estimated 1.95 direct catastrophic injuries per year, or 0.43 injuries per 100,000 participants. The most common mechanisms of injury were a collision of fielders (9) or of a base runner and a fielder (8), a pitcher hit by a batted ball (14), and an athlete hit by a thrown ball (4). Catastrophic injuries included 23 severe head injuries, 8 cervical injuries, 3 cases of commotio cordis, and 2 cases each of a collapsed trachea and facial fractures. Three athletes sustained a severe head injury and facial fractures. Ten of the 41 injuries were fatalities. CONCLUSIONS: Suggestions for reducing catastrophic injuries in baseball include teaching proper techniques to avoid fielding and baserunning collisions, protecting the pitcher via a combination of screens and/or helmets with faceguards, continued surveillance and modifications of the bat and ball, eliminating headfirst slides, and continued analysis of chest protectors and automatic external defibrillators for commotio cordis.     

Ulnar collateral ligament injury in the overhead athlete: diagnosis and treatment

The ulnar collateral ligament (UCL) is more commonly injured than previously suggested. Injury to this ligament can result in secondary symptoms and problems in other parts of the elbow, including the ulnar nerve, the flexor-pronator musculotendinous unit, the radiocapitellar joint, and the posterior compartment of the elbow, in addition to being a cause of loose bodies within the elbow. This article briefly reviews the anatomy, biomechanics, and pathophysiology of injury, in addition to discussing evaluation and treatment of the athlete with an injured UCL.     

Clinical interpretation of asymptomatic medial collateral ligament injury observed on magnetic resonance imaging in adolescent baseball players

Purpose

Magnetic resonance imaging (MRI) of medial collateral ligament (MCL) injury of the elbow was often observed in asymptomatic adolescent baseball players. We aimed to clarify the clinical interpretation of “asymptomatic MCL injury observed on MRI” by comparing MRI, ultrasonography (US), and physical findings.

Materials and methods

Sixty-four asymptomatic adolescent baseball players (mean 11.2 years) were enrolled. An open-type 0.2T MRI was used. MCL function was evaluated by measuring the opening of the ulnohumeral joint using US. Physical findings included MCL tenderness, the moving valgus test, and the Milking test. The correlation between MRI and US, and MRI and physical findings were analyzed.

Results

Thirty-four subjects (53.1%) showed MCL injury by MRI. The mean laterality of the ulnohumeral joint opening showed no significant difference (P = 0.16) between the group with (0.29 ± 1.06 mm) and without (0.08 ± 0.96 mm) MCL injury on MRI. There was no correlation between MRI and physical findings except for a weak correlation between subjects with positive Milking test and MCL injury on MRI (φ coefficient = 0.3, P = 0.02).

Conclusion

‘Asymptomatic MCL injury on MRI’ had little correlation to ligament dysfunction. It might represent the transition period to MCL thickening called “adaptation.”

     

Risk factors for injury in high school football players

BACKGROUND: Many studies have reported the frequency and types of injuries in high school football players. However, few have assessed the relationship between player characteristics and risk of injury. PURPOSE: To describe the epidemiologic characteristics of and risk factors for injury in high school football players and to determine whether players' characteristics could be used to predict subsequent injury. STUDY DESIGN: Prospective cohort study. METHODS: This study was part of a 2-year prospective investigation (1998 to 1999) of risk factors for injury in 717 (343 in the 1998 season and 374 in the 1999 season) high school football players in the Oklahoma City, Oklahoma, School District. Player characteristics (playing experience, position, injury history) and physical parameters (body mass index, weight, height, grip strength) were measured at the beginning of each season. Logistic regression analysis was used to determine whether any of the baseline variables were associated with the odds of subsequent injury. RESULTS: The physical characteristics of players, such as body mass index and strength, were not associated with risk of injury. More playing experience and a history of injury in the previous season were significantly related to increased risk. Linemen were at the highest risk of injury, particularly knee injuries and season-ending injuries. CONCLUSIONS: Future research should focus on decreasing the risk of injury to linemen.     

Primary reconstruction of the medial collateral ligament in combined injury of the medial collateral and anterior cruciate ligaments Short-term results

We describe our experiences with 22 patients who underwent acute surgical intervention for complete combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in our hospital. In all patients, an arthroscopically guided repair of the MCL was performed, while the torn ACL was treated non-surgically. Primary reconstruction of the MCL in patients with complete disruptions of the MCL complex as well as the ACL reduces combined anteromedial instability to an isolated problem of the ACL. As a result of this treatment, the condition of 15 of 22 knees was improved, after an average duration of follow-up of 2 and a half years. In conclusion, our treatment strategy of an immediate repair of the MCL and reconstruction of the ACL when conservative treatment has failed seems safe and effective. Received: 30 January 1997 Accepted: 25 September 1997     

Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers

Sonography is a valuable method for imaging superficial tendons and ligaments. The ability to obtain comparison images easily with dynamic stress allows assessment of ligament and tendon integrity. We studied the medial elbow joints of two baseball pitchers using MR imaging and dynamic sonography. Both sonography and MR imaging identified the ulnar collateral ligament tears. Dynamic sonography uniquely demonstrated the medial joint instability.     

Risk factors for injury in middle school football players

BACKGROUND: Little is known about the frequency of or risk factors for injuries in middle school or junior high school football players. PURPOSE: To examine the associations of player characteristics (injury history, conditioning, player position, special equipment) and physical parameters (body mass index, weight, height, grip strength) with risk of injury. STUDY DESIGN: Prospective cohort study. METHODS: We documented risk factors for injury in 646 middle school football players, 10 to 15 years of age, in the Oklahoma City, Oklahoma, school district during the 1998 and 1999 seasons. Player characteristics and physical parameters were measured at the beginning of both seasons. Logistic regression methods were used to determine whether baseline variables were associated with the odds of subsequent injury. RESULTS: More playing experience was the only variable significantly associated with the risk of injury in multivariate analyses. This association was observed regardless of the type of injury and even after indirectly controlling for time at risk of injury by restricting analyses to first-string players. Increasing age was significantly associated with the risk of fractures. CONCLUSIONS: Results suggest that physical characteristics play a minor role in risk of injury from football in this age group.     

Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases

BACKGROUND: Although various surgical procedures that attempt to restore the function of the medial collateral ligament have been reported, none have achieved consistently satisfactory results. HYPOTHESIS: Our reconstructive procedure using autogenous semitendinosus and gracilis tendons yields improved results compared with conventional procedures. STUDY DESIGN: Case series. Level of evidence, 4. METHOD: In our surgical procedure, autogenous semitendinosus and gracilis tendons were used to anatomically reconstruct the anterior longitudinal component of the superficial medial collateral ligament. From April 1995 through December 2000, 27 patients with symptomatic medial instability underwent this surgical procedure. The majority of the subjects were diagnosed with combined cruciate ligament injuries, necessitating concomitant cruciate ligament reconstructions. Of these 27 patients, 24 were evaluated after a minimum period of 2 years, with a mean follow-up period of 27 months (range, 24-48 months). RESULTS: At follow-up, medial stability, as well as postoperative range of motion in all patients, was graded as normal or nearly normal according to the International Knee Documentation Committee evaluation system. No significant postoperative complications were encountered. CONCLUSION: Although this is a short-term follow-up study involving a small number of cases, we considered our procedure to be an effective method of surgically restoring the function of the medial collateral ligament.     

Review of cardiometabolic risk factors among current professional football and professional baseball players

Data on the development of cardiovascular disease in professional football players are conflicting. Studies have documented a higher prevalence of obesity, lower high-density lipoprotein cholesterol levels, increased left ventricular and left atrial size, and higher prevalence of metabolic syndrome in former professional football linemen compared with nonlinemen. It has been suggested that former National Football League players are at risk for early cardiovascular disease and premature death. A print media report in 2006 indicated an increased prevalence of cardiovascular disease and early mortality in professional football players compared with professional baseball players. However, there has been little scientific evaluation of cardiovascular risk factors in professional baseball players. Our data suggest that there is increased cardiovascular disease risk in football players, but this is limited to heavier linemen. In preliminary studies, baseball players do not appear to demonstrate the same increased risk. However, caution should be used in the interpretation of increased cardiovascular disease risk, as it does not necessarily translate into early increased mortality.