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Most pitchers returned to sport after medial epicondyle ORIF
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NEW YORK —Most professional baseball pitchers were able to return to sport after open reduction and internal fixation of the medial epicondyle without a significant decline in most performance variables, according to results presented here.
Anthony A. Romeo, MD, and colleagues recorded demographic and performance data for 15 professional baseball pitchers who had a history of ulnar collateral ligament reconstruction and underwent open reduction and internal fixation (ORIF) of the medial epicondyle.
In his presentation at the American Shoulder and Elbow Surgeons Annual Meeting, Romeo noted 73% of patients returned to sport. Of these patients, 55% returned at the same level or higher. When comparing preoperative and postoperative performance, he added there were no significant differences in the primary performance outcome variables.
“There were no significant differences in the primary performance outcome measures that were seen between the cases and the controls, which are other pitchers who are matched in almost every way possible except for the surgery and complication,” Romeo said.
Although there were no differences between patients who underwent ORIF and controls in the primary performance measures, Romeo noted there was a statistically significant difference in the secondary performance measure of the number of innings pitched per year.
“The cases pitched fewer innings when compared to controls following open reduction and internal fixation,” Romeo said. – by Casey Tingle
Reference:
Erickson BJ, et al. Paper 24. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.
Disclosure: Romeo reports he receives other financial or material support from the Arthroscopy Association of North America, Arthrex Inc. and Major League Baseball; research support from Aesculap/B.Braun, Arthrex Inc., Histogenics, Medipost, NuTech, OrthoSpace, Smith & Nephew and Zimmer; is a board or committee member for American Shoulder and Elbow Surgeons, Atreon Orthopaedics and Orthopedics Today; receives IP royalties, is a paid consultant and paid presenter or speaker for Arthrex Inc.; is on the editorial or governing board for Orthopedics, Orthopedics Today, SAGE, SLACK Incorporated and Wolters Kluwer Health – Lippincott Williams & Wilkins; and receives publishing royalties, financial or material support from Saunders/Mosby-Elsevier and SLACK Incorporated.
Perspective
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Joshua S. Dines, MD
Ulnar collateral ligament reconstruction is an increasingly common procedure used to treat ligament insufficiency in baseball pitchers of all levels. Surgical techniques and success rates have improved, but complications can still occur such as a fracture of the medial epicondyle.
In this new study, Brandon J. Erickson, MD, and colleagues retrospectively reviewed a Major League Baseball injury database to identify patients who experienced this complication. They found that 73.3% of patients returned to baseball, yet only 55% were able to return to their previous level of play; an important distinction in studies of outcomes in professional athletes.
Medial epicondyle avulsions are more common in adolescent athletes because the ligament is stronger than the bone. In older athletes, the ligament becomes the weak link leading to UCL tears. During ligament reconstruction, tunnels or sockets are drilled in the medial epicondyle clearly weakening the bone, which is the likely cause of medial epicondyle fractures in professional athletes. While different reconstruction techniques (American Sports Medicine Institute) remove more bone than others (Docking, DANE TJ), the number of athletes reviewed in this study was too small to draw conclusions about the relative risk of medial epicondyle fracture after a given technique.
I was involved in a different study that found that the modified Jobe technique reduced osseous vascularity more than docking technique after UCL reconstruction. This, combined with the increased bone removal, may lead to this complication occurring more commonly with the modified Jobe technique.
Erickson and his colleagues should be commended on their excellent paper. Due to its increasing popularity, many assume that the results of UCL reconstruction are uniformly outstanding. This paper highlights one potential complication after reconstruction and shows how difficult it can be to get professional athletes back to their previous level of play.
Reference:
Camp CL, et al. Orthop J Sports Med. 2018;doi:10.1177/2325967118763153.
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