Surgical Versus Nonoperative Treatment Of Ulnar Collateral Ligament Tears In Overhead Athletes Return To Sport

Ulnar collateral ligament (UCL) injuries are common in overhead athletes. The literature comparing treatment options on return to play (RTP) is limited. PURPOSE: To complete a meta-review evaluating the effectiveness of surgical and nonoperative UCL interventions in returning competitive overhead athletes to sport. METHODS: We systematically searched 2 databases for peer-reviewed systematic reviews (SR) and meta-analyses (MA) published in English to March 10, 2024. Included SR/MAs: investigated case studies/series and cohort studies; compared surgical and nonsurgical treatments for UCL tears in competitive overhead athletes; and reported RTP outcomes. Studies investigating repeat tears, adolescents, and non-overhead athletes were excluded. RESULTS: In all, 7 reviews qualified (4 SR/3 MAs); 5 involved surgical (3 SR/2 MAs), and 2 involved nonoperative (1 SR/1 MA) interventions. The sample totaled 4972 mostly male (80%) overhead athletes; of these, 4763 (96%) were baseball players, 4411 (89%) underwent surgery, and 561 (11%) received nonoperative treatment. RTP time after surgery was 6-85mos. Following surgery, RTP rates were 67-100% with college baseball players (n = 610) having 95% and Major League baseball players (n = 907) an 89% rate. After nonoperative treatment, RTP took 1-54wks with rates of 95% for college, 87% for high school, and 75% for professional athletes. After nonoperative treatment, athletes with low grade UCL injuries (n = 340) had RTP rates of 80-100%, while those with high grade injuries (n = 42) had rates of 12-69%. All SR/MAs, regardless of treatment, identified an unquantified decrease in workload after intervention. CONCLUSION: Most competitive overhead athletes returned to play following primary UCL injury, independent of treatment. Treatment type, level of competition, and injury grade appear to impact rehabilitation and RTP time. Research is needed to examine these important considerations to optimize RTP and performance after UCL injury.