Platelet Rich Plasma Treatment in Collegiate Baseball Players Who Suffered Partial Ulnar Collateral Ligament Tears: A Case Series from a Single Center’s Experience in Return to Play and Performance

Anant Shukla,1,2 Jack E Kilgore III,3 Christopher Frey,2,4 Logan M Locascio,2 Alicia Hymel,2 Chris P Matarazzo,2 Lauren Porras2 1Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; 2Department of Orthopedic Surgery, Sports Medicine Division, Vanderbilt University Medical Center, Nashville, TN, USA; 3Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; 4UTHealth Houston, Department of Orthopedic Surgery, Houston, TX, USACorrespondence: Anant Shukla, Email [email protected] Jack E Kilgore III, Email [email protected]: Elbow ulnar collateral ligament (UCL) injuries can cause pain and decreased performance for the overhead athlete. Platelet-rich plasma (PRP) therapy is becoming more common to avoid surgery in partial UCL tears and improve return to play, but the literature is sparse regarding functional outcomes. This study aimed to characterize elbow UCL injuries among 5 collegiate baseball pitchers describe their return to play after PRP treatment, and compare dynamometry assessments before injury and after treatment.Methods: Data from 5 Division 1 baseball pitchers who sustained low- to intermediate-grade UCL injuries determined by ultrasonography and/or magnetic resonance imaging were retrospectively reviewed. All athletes underwent one PRP injection, physical therapy, and a standardized return to play protocol as part of their treatment. Dynamometry measures were taken prior to injury (pre-season) as well as at the conclusion of the return-to-play protocol.Results: Five consecutive baseball players with UCL injuries were evaluated. Pre-season dynamometry testing was performed on all players prior to the seasons and when they first arrived to the team. Players received PRP injections on average 36 days after their injury and started a standardized rehab program on average about 48 days after PRP. Players were cleared to full return to play at a mean 174 days post-injury. Follow-up examination at that time demonstrated full range of motion of the elbow without tenderness to palpation over the UCL for all athletes. All athletes were able to continue to play at the same level of competition as before the injury occurred without any complaints. No players had repeat injuries during the same or following seasons. Comparing pre-injury to clearance dynamometry, external rotation measures on average slightly decreased from 194 to 190 Newtons while grip strength increased from 586 to 646 Newtons, on average.Conclusion: Successful return to play was possible in 5 collegiate baseball pitchers after nonoperative treatment including injection of PRP at a mean 174 days following injury. PRP treatment gives promising results in low and intermediate partial UCL injury. Performance metrics including external rotation and grip strength were consistent pre-injury and upon clearance.Keywords: ulnar collateral ligament, elbow, baseball, platelet rich plasma, nonoperative management results, return to play