UCL reconstruction: Good results lead to potential overuse in young athletes

ORLANDO, Fla. — A long-term study of ulnar collateral ligament reconstruction indicates that the procedure produces better results than ulnar collateral repair and that good to excellent results can be expected in athletes at all levels of play.

However, a study co-author noted that along with the success has come an alarming trend of an increased utilization of the surgery in younger athletes.

In a presentation to the 2008 American Orthopaedic Sports Medicine Society (AOSSM) Annual Meeting, E. Lyle Cain Jr., MD, of Birmingham, Ala., presented the 19-year, more-than-1,200 patient surgical experience of James R. Andrews, MD.

The surgeon's results, culled from the database at the American Sports Medicine, Institute, Andrews Sports Medicine and Orthopaedic Center, found that 942 patients had ulnar collateral ligament (UCL) reconstructions, widely known as Tommy John surgery, or repairs; 736 were available for 2-year follow up.

The patients were primarily men at an average age of 21.5 years old, ranging from 14 to 59 years; about 95% of the overall population were baseball players, 32% of them professional players-86 major league players, and 300 minor leaguers.

"In terms of return to sports, 84% of reconstructions and 70% of repairs were able to return to the same level of competition or higher. The average time to throw was 4.4 months, the average time to competitive throw was 11.7 months and in professional baseball players it was 1 year," he said.

Cain said the investigation found that 76% of major league baseball players returned to the major-league level, 15% returned to minor league level, and 9% were unable to return to pitching. Overall there was a 14% complication rate.

At an AOSSM webinar press conference 2 weeks prior to the meeting, Cain said, "Before 1997 this surgery was performed on only 12 of 97 patients who were 18 or younger (12%). In 2005 alone, 62 of the 188 operations performed, were on high school athletes, a third of the surgical group. The reality is that this surgery is successful and that's good. But a disturbing trend of younger kids needing the surgery is troubling. This should be a wake-up call to parents and coaches that specialization in baseball ,where kids don't get adequate time off, is very dangerous."

Cain, who is fellowship director for the institute said the increased numbers can be attributed to improved diagnostic techniques, heightened awareness, increased chance of positive outcome with current surgical techniques, "but most importantly, the overuse of young throwing arms."

He said the proliferation of year-round baseball leagues has increased the number of pitches that young athletes throw. "So the best young pitchers are throwing many more pitches and learning to throw more difficult pitches. It's great that the surgery is successful, but prevention of the injury should be the goal. Kids should be urged to rest and be careful about saving their arms, rather than leading to long-term problems at a young age."

For more information:
Cain EL, Andrews JR, Dugas JR, et al. Ulnar collateral ligament reconstruction of the elbow: Results of more than 1,000 cases with a minimum 2-year follow-up. Presented at the 2008 American Orthopaedic Society for Sports Medicine Annual Meeting. July 10-13, 2008. Orlando.