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Meta-Analysis
. 2023 Dec;51(14):3858-3869.
doi: 10.1177/03635465221150507. Epub 2023 Mar 6.

Return to Sport After Nonoperative Management of Elbow Ulnar Collateral Ligament Injuries: A Systematic Review and Meta-analysis

Varun Gopinatth  1   2 , Anjay K Batra  2 , Zeeshan A Khan  2 , Garrett R Jackson  2 , Harkirat S Jawanda  2 , Enzo S Mameri  2 , Johnathon R McCormick  2 , Derrick M Knapik  3 , Jorge Chahla  2 , Nikhil N Verma  2
Affiliations
Meta-Analysis

Return to Sport After Nonoperative Management of Elbow Ulnar Collateral Ligament Injuries: A Systematic Review and Meta-analysis

Varun Gopinatth et al. Am J Sports Med. 2023 Dec.

Abstract

Background: Elbow ulnar collateral ligament (UCL) injuries can result in significant functional impairment in throwing and overhead athletes. UCL reconstruction and repair are proven treatments to restore stability, but the efficacy of nonoperative management is unclear.

Purpose: To determine the rate of return to sports (RTS) and return to previous level of play (RTLP) in athletes sustaining medial elbow ulnar collateral ligament (UCL) injuries treated nonoperatively.

Study design: Systematic review; Level of evidence, 4.

Methods: A literature search was performed using Scopus, PubMed, Medline, the Cochrane Database for Systematic Review, and the Cochrane Central Register for Controlled Trials according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Inclusion criteria were limited to level 1 to 4 human studies reporting on RTS outcomes after nonoperative management of UCL injuries.

Results: A total of 15 studies, consisting of 365 patients with a mean age of 20.45 ± 3.26 years, were identified. Treatment primarily consisted of platelet-rich plasma (PRP) injections with physical therapy (n = 189 patients; n = 7 studies) versus physical therapy alone (n = 176 patients; n = 8 studies). The overall RTS rate was 79.7% and the overall RTLP rate was 77.9%. Increasing UCL injury severity grade was associated with lower RTS rates. The RTS rate for proximal tears (89.7%; n = 61/68) was significantly greater than that for distal tears (41.2%; n = 14/34) (P < .0001). No significant difference in RTS rate was seen in patients treated with PRP versus those who did not receive PRP (P = .757).

Conclusion: For athletes undergoing nonoperative management of UCL injuries, the overall RTS and RTLP rates were 79.7% and 77.9%, respectively, with excellent outcomes in grade 1 and grade 2 UCL injuries, specifically. The RTS rate for proximal tears was significantly higher than that for distal tears. Athletes were most commonly treated with PRP injection and physical therapy.

Keywords: athlete; platelet-rich plasma; rehabilitation; return to sport; ulnar collateral ligament.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.R.M. has received support for education from Medwest Associates. D.M.K. has received support for education from Smith & Nephew, Elite Orthopedics, and Medwest Associates; a grant from Arthrex; and hospitality payments from Arthrex, Encore Medical, and Stryker. J.C. has received consulting fees from Arthrex, CONMED Linvatec, Ossur, Smith & Nephew, Vericel, and DePuy Synthes Products; support for education from Arthrex, Medwest Associates, and Smith & Nephew; speaking fees from Linvatec; and hospitality payments from Medical Device Business Services, Smith & Nephew, and Stryker. N.N.V. has received research support from Wright Medical Technology, Ossur, and Breg; consulting fees from Arthrex, Smith & Nephew, Stryker, Minivasive, and Medacta USA; personal fees from DJ Orthopedics and Orthospace; royalties from Arthrex, Smith & Nephew, and Graymont Professional Products; and support for education from Medwest Associates; he holds stock or stock options in Cymedica, Minivasive, and Omeros. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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