Does posteromedial chondromalacia reduce rate of return to play after ulnar collateral ligament reconstruction?

Abstract

Background: Biomechanical studies suggest ulnohumeral chondral and ligamentous overload (UCLO) explains the development of posteromedial chondromalacia (PMC) in throwing athletes with ulnar collateral ligament (UCL) insufficiency. UCL reconstruction reportedly allows 90% of baseball players to return to prior or a higher level of play; however, players with concomitant posteromedial chondromalacia may experience lower rates of return to play.

Questions/purposes: The purpose of this investigation is to determine: (1) the rates of return to play of baseball players undergoing UCL reconstruction and posteromedial chondromalacia; and (2) the complications occurring after UCL reconstruction in the setting of posteromedial chondromalacia.

Methods: We retrospectively reviewed 29 of 161 (18%) baseball players who were treated for the combined posteromedial chondromalacia and UCL injury. UCL reconstruction was accomplished with the docking technique, and the PMC was addressed with nothing or débridement if Grade 2 or 3 and with débridement or microfracture if Grade 4. The mean age was 19.6 years (range, 16-23 years). Most players were college athletes (76%) and pitchers (93%). We used a modified four-level scale of Conway et al. to assess return to play with 1 being the highest level (return to preinjury level of competition or performance for at least one season after UCL reconstruction). The minimum followup was 24 months (mean, 37 months; range, 24-52 months).

Results: Return to play was Level 1 in 22 patients (76%), Level 2 in four patients (14%), Level 3 in two patients (7%), and Level 4 in one (3%) patient.

Conclusions: Our data suggest baseball players with concomitant PMC, may have lower rates of return to the same or a higher level of play compared with historical controls.

Level of evidence: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

MR image is shown of a baseball player with an ulnohumeral chondral and ligamentous (UCL) tear in the setting of posteromedial chondromalacia (arrow) and a large posteromedial osteophyte (arrow).

Fig. 2A–B

Intraoperative elbow arthroscopy photograph is shown of Grade 2 posteromedial chondromalacia (arrow) (A) before and (B) after débridement. Note the associated chondral flap injury (arrow) being elevated by a probe, which is subsequently débrided.

Fig. 3A–B

Intraoperative elbow arthroscopy photograph is shown of Grade 4 posteromedial chondromalacia (arrow) (A) before and (B) after microfracture treatment.

Fig. 4A–B

Intraoperative elbow arthroscopy photograph is shown of a posteromedial osteophyte (arrow) (A) before and (B) after resection.