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Distal UCL tears had higher rates of failure vs proximal tears with nonoperative care

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Results presented at the American Orthopaedic Society for Sports Medicine Annual Meeting showed significantly higher rates of failure for patients with distal ulnar collateral ligament tears compared with proximal tears initially treated with nonoperative management.

Between 2006 and 2015, researchers identified 32 professional pitchers who had ulnar collateral ligament (UCL) injuries and underwent nonoperative treatment. Researchers defined success as return to the same level of play or higher for more than 1 year, while failure was defined as recurrent pain or weakness requiring surgical intervention after a minimum of 3 months of rest when attempting to return to a throw rehabilitation program.

Overall, results showed 36% of patients failed and required subsequent ligament reconstruction. Researchers found no significant differences in total shoulder arc of motion, shoulder internal rotation deficit or loss in elbow extension at the time of injury between the success and failure groups. Researchers noted MRI findings showed 90% of patients who failed nonoperative management had distal tears vs. 18.2% of patients who had successful nonoperative treatment. According to results, distal tears had a 22.7-times greater likelihood of failure with nonoperative management after investigators adjusted findings for age, location and evidence of chronic changes in MRI.

“Sports medicine physicians should strongly consider an initial nonoperative approach for treatment of athletes with proximal ulnar collateral ligament sprains,” Mark S. Schickendantz, MD, told Healio.com/Orthopedics. “Alternatively, those athletes who have distal injuries as seen on MRI should be strongly considered for early surgery.” – by Casey Tingle

Reference:

Frangiamore S, et al. Paper #116. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 7-10, 2016; Colorado Spring, Colo.

Disclosure: Schickendantz reports he is a paid consultant for Arthrex.