Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2016; 7(6): 355-360
Published online Jun 18, 2016. doi: 10.5312/wjo.v7.i6.355
Medial ulnar collateral ligament reconstruction of the elbow in major league baseball players: Where do we stand?
Brandon J Erickson, Bernard R Bach Jr, Charles A Bush-Joseph, Nikhil N Verma, Anthony A Romeo
Brandon J Erickson, Bernard R Bach Jr, Charles A Bush-Joseph, Nikhil N Verma, Anthony A Romeo, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL 60611, United States
Author contributions: Erickson BJ, Bach Jr BR, Bush-Joseph CA, Verma NN and Romeo AA designed this study, wrote and edited the manuscript.
Conflict-of-interest statement: No author has any conflicts of interest that pertain to the submitted article. Other conflicts of interest are listed in the document of conflict-of-interest statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Brandon J Erickson, MD, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL 60611, United States.
Telephone: +1-732-4925775 Fax: +1-312-9422040
Received: January 25, 2016
Peer-review started: January 25, 2016
First decision: February 29, 2016
Revised: March 8, 2016
Accepted: March 24, 2016
Article in press: March 25, 2016
Published online: June 18, 2016

The ulnar collateral ligament (UCL) is a vital structure to the overhead athlete, especially the baseball pitcher. For reasons not completely understood, UCL injuries have become increasingly more common in major league baseball (MLB) pitchers over the past 10 years. UCL reconstruction (UCLR) is the current gold standard of treatment for these injuries in MLB pitchers who wish to return to sport (RTS) at a high level and who have failed a course of non-operative treatment. Results following UCLR in MLB pitchers have been encouraging, with multiple RTS rates now cited at greater than 80%. Unfortunately, with the rising number of UCLR, there has also been a spike in the number of revision UCLR in MLB pitchers. Similar to primary UCLR, the etiology of the increase in revision UCLR, aside from an increase in the number of pitchers who have undergone a primary UCLR, remains elusive. The current literature has attempted to address several questions including those surrounding surgical technique (method of exposure, graft choice, management of the ulnar nerve, concomitant elbow arthroscopy, etc.), post-operative rehabilitation strategies, and timing of RTS following UCLR. While some questions have been answered, many remain unknown. The literature surrounding UCLR in MLB pitchers will be reviewed, and future directions regarding this injury in these high level athletes will be discussed.

Keywords: Ulnar collateral ligament, Ulnar collateral ligament reconstruction, Tommy John, Major league baseball, Pitcher, Baseball

Core tip: The number of ulnar collateral ligament (UCL) tears in major league baseball athletes is increasing with time. UCL reconstruction (UCLR) has become the gold standard for treatment of UCL tears. The outcomes of this surgery in elite level athletes is encouraging, with return to sport rates typically > 80%. Results following revision UCLR are less encouraging. Currently, there is no standardized rehabilitation protocol or timing to return to sport. Future research into graft choice, surgical technique, management of the ulnar nerve, and rehabilitation protocols must be done to achieve the best possible results in this elite group of athletes.