Return to Play after Nonsurgical Treatment of Elbow Ulnar Collateral Ligament Injuries in Professional Baseball Players

OBJECTIVES: Injury to the elbow ulnar collateral ligament (UCL) is relatively common in pitchers. In the 70's reconstructive surgery was developed as a viable option to a potentially career ending injury. Multiple studies have demonstrated return to play (RTP) rates of 74-83% after reconstruction. Studies of RTP after nonoperative treatment in throwing athletes are limited, reporting 42%. There are no studies reporting RTP rates with nonoperative treatment of professional baseball players. The purpose of this study was to identify professional baseball players' ability to return to play after UCL injuries based on nonoperative vs. operative treatment, MRI grade, and player position. METHODS: A retrospective review of a single professional baseball organization (6 minor league teams and 1 Major league team) between 2006 & 2011 revealed 72 medial elbow injuries. MRI was performed on all players. UCL injuries were diagnosed in 45 players by physical exam & MRI. Players were treated with rehabilitation, surgery or both. Success was RTP for >1 season. Rates of RTP and return to the same level of play or higher (RTSP) were calculated and correlated with MRI grade, location, and player position. MRI grading used was: 1 intact ligament +/- edema, 2 partial tearing, 3 complete tear, and 4 chronic healed injury. RESULTS: Overall 91% of 45 players had RTP, and 87% had RTSP. Fifteen were treated surgically and 30 nonoperatively with rehab. Of players treated surgically, 73% had RTSP, whereas 93% of nonoperatively treated players had RTSP (p-value 0.07). All players with grade III tears had surgery. Of surgically treated players, none had grade I injuries, 13% had grade II injuries, 53% had grade III injuries, and 33% had grade IV injuries. Of nonoperatively treated players, 13% had grade I injuries, 23% had grade II injuries, none had grade III injuries, and 60% had grade IV injuries. Of all grade II and grade IV injuries, 78% were treated nonoperatively and all but 1 player in each group (treated nonoperatively) had successful RTSP. Of the players treated for grade III tears, 50% had RTSP, whereas 92% of players treated for incomplete (grades I, II and IV) injuries had RTSP (p-value 0.01), regardless of treatment. When considering RTP rather than RTSP for complete vs. incomplete injuries, the rates improved to 75% and 95% (p-value 0.13) respectively. All grade I injuries, 86% of grade II injuries and 91% of grade IV injuries had RTSP. Of the 45 players with UCL injuries, 33 were pitchers. Among pitchers treated surgically RTP was 86% and RTSP was 71%. Nonoperatively treated pitcher’s RTP and RTSP was the same, 95%. Among the pitchers, 24% had grade III injuries whereas none of the positional players had grade III injuries. Ten of 11 positional players treated nonoperatively had RTSP. One positional player was treated operatively and had RTSP. CONCLUSION: Professional baseball players treated nonoperatively for UCL injuries have a much higher RTP rate than previously published among throwing athletes. Pitchers are more likely to develop UCL injuries than positional players and are more likely to have complete tears leading to surgical treatment. Incomplete UCL injuries are more likely to lead to nonoperative treatment and a higher RTSP than complete tears. RTP and RTSP occurs at a higher rates for non-pitchers than pitchers. MRI grade of UCL injuries can help predict the potential for RTP and need for surgery.