Validation study of novel grading system for ulnar collateral ligament injury of the elbow with high-resolution magnetic resonance imaging

BACKGROUND: Recently, magnetic resonance imaging (MRI) classification of medial ulnar collateral ligament (UCL) tears has been introduced, but little is known about the relationship between MRI grading and medial joint laxity. It has been reported that microscopy coils could make it possible to achieve high-resolution images of upper extremities with a superior diagnostic ability to conventional MRI. However, there is no report that has compared the diagnostic reliability between microscopic and conventional MRI. The purpose of this study was to assess the relationship between MRI findings and medial joint laxity evaluated with stress ultrasound (US). Secondary objective was to compare the reliabilities of UCL evaluation between microscopic and conventional MRI. METHODS: One-hundred thirty baseball players who underwent MRI of the elbow for the diagnosis of UCL injury using both conventional and microscopy MRI were included in this study. They also underwent stress US for assessment of medial joint laxity against valgus stress. Our MRI grading system for UCL injuries was compared to medial joint laxity evaluated with stress US. The intrarater and interrater reliabilities of our grading system were assessed with both microscopic and conventional MRI. RESULTS: Our grading system was related to valgus stability, especially with microscopic MRI. The reliabilities were fair when combined with microscopic MRI, which exhibited better intrarater and interrater reliabilities than conventional MRI. CONCLUSION: High-resolution microscopic MRI may contribute to the accurate diagnosis of UCL injuries.