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Ulnar Collateral Ligament Reconstruction:

The Rush Experience

Brandon J. Erickson MD, Bernard R. Bach Jr. MD, Mark S

Cohen, Charles A. Bush-Joseph MD, Brian J. Cole, Nikhil N.

Verma, Gregory P. Nicholson, and Anthony A. Romeo MD

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• No relevant disclosures.

• Funding sources:

– KFx Medical

– AANA

– Accelerated Rehabilitation Centers Ltd.

– MAOA

I (and/or my co-authors) have something to disclose.

Detailed disclosure information is available via:

“My Academy” app;

Printed Final Program; or

AAOS Orthopaedic Disclosure Program on the AAOS website athttp://www.aaos.org/disclosure

My Academy

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Overuse injuries to the elbow in the throwing athlete are

frequent. Ulnar collateral ligament reconstruction (UCLR),

commonly known as Tommy John surgery, is performed

on athletes from all levels of competition.

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cePURPOSES

• Review all UCLR performed at a single

institution between January 2004 – July 2014

• Report:• Patient Demographics

• Clinical Outcomes

• Return to Sport Rate

• Complications

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1. There will be a significant increase in the number of

UCLR performed over time

1. Return to sports rates would be >80%

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• Surgical database of a single group practice was

reviewed from January 1st 2004-July 1st 2014

• Current procedural terminology (CPT) for UCLR, 24346,

was used to search the database

• 187 patients (188 elbows)

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• Electronic charts were reviewed for all patients to

determine:• Patient age

• Sex

• Hand dominance

• Presence or absence of pre-op ulnar nerve sx

• Physical exam findings

• Prior elbow surgeries

• Traumatic or atraumatic injury

• Sport played (if any)

• Level of sport played (high school, collegiate, professional,

recreational)

• Surgical technique

• Whether a concomitant arthroscopy and/or ulnar nerve

transposition was performed

• Graft type

• Complications

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• Patients with working phone numbers on file who were

more than 18 months out from surgery were then

contacted by the lead author via phone calls

• Patients were asked about

• Ability or inability to return to sport

• Function on return to sport (same, better, or worse)

• Any complications they experienced

• Conway-Jobe score

• Timmerman & Andrews score

• Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder

and Elbow score

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0

5

10

15

20

25

30

35

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Nu

mb

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of

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Year

P=0.0017

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0

5

10

15

20

25

30

35

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Avera

ge P

ati

en

t A

ge

Year

P=0.83

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0

10

20

30

40

50

60

1 2 3 4

Nu

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of

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Yearly Quarter

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Middle School

Athlete at time

of surgery?

High School

Athlete at time

of surgery?

College Athlete

at time of

surgery?

Professional

Athlete at time

of surgery?

Recreational

Athlete at time

of Surgery

Number of

1 68 97 7 15

Patients

Results

Baseball

Player?

(former or

current)

Pitcher?Non-

Pitcher

Softball

Player?

MLB

Player?

Volleyball

Player?

Football

Player?Gymnast?

Number of165 155 10 4 7 2 6 4

Patients

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Graft

Choice

Ipsilateral

Palmaris

Autograft

Contralateral

Palmaris

Autograft

Hamstring

Autograft

Triceps

Autograft

Palmaris

Allograft

Hamstring

Allograft

Number of

Patients111 2 48 2 2 24

Yes No

Ulnar Nerve

Transposed?79 108

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Sport Return to Previous Level? Andrews & Timmerman KJOC

Baseball 94.70% 92.8 +/- 6.8 90.8 +/- 5.8

Baseball Pitcher 92.10% 92.8 +/- 6.8 90.5 +/- 5.8

Baseball Non-Pitcher 100% 95 +/- 7.1 94.5 +/- 2.1

Softball 100% 95 +/- 7.1 90.7 +/- 0.9

Gymnastics 50% 87.5 +/- 3.5 76.3 +/- 24.5

Football 100% 100 92

Cheerleader 100% 85 94.7

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• 5.3% (10/187) of patients underwent subsequent surgeries

• Removal of the cortical fixation button (1 patient)

• Subsequent ulnar nerve transposition (7 patients)

• Elbow arthroscopy for loss of motion (1 patient)

• Revision UCLR (1 patient)

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• No pre-operative scores

• KJOC score is not validated for phone use yet

• Could not contact all patients for outcome data

• No physical exam was performed (ROM, strength, etc.)

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ceCONCLUSIONS

1. UCLR was performed most commonly on

collegiate athletes using an ipsilateral

palmaris longus graft

2. Both the standard and double docking

techniques are viable surgical techniques

when performing an UCLR

1. Overall 94.1% of patients who underwent

UCLR were able to return to sport with an

average KJOC score of 90.4 and Timmerman

Andrews Score of 92.5

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