The incidence of ulnar collateral ligament injuries has increased over the past decade. As a result, the rate of ulnar collateral ligament reconstruction has increased dramatically at all levels of competition in overhead athletes. Currently, there is no consensus on milestones during rehabilitation or a largely agreed-upon structured throwing program after ulnar collateral ligament injuries. It is important to outline the criteria that should be met during rehabilitation and provide an evidence-based structured throwing program that can be implemented to improve and optimize an athlete's chances of returning to the same level of throwing. These guidelines may be used for rehabilitation after an injury is managed surgically or nonsurgically.

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The incidence of ulnar collateral ligament injuries has increased over the past decade. As a result, the rate of ulnar collateral ligament reconstruction has increased dramatically at all levels of competition in overhead athletes. Currently, there is no consensus on milestones during rehabilitation or a largely agreed-upon structured throwing program after ulnar collateral ligament injuries.

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The medial ulnar collateral ligament (MUCL) complex is integral for valgus elbow stability, especially in individuals engaged in repetitive overhead activities such as throwing. MUCL injuries often necessitate surgical intervention to restore elbow stability. Early studies reporting outcomes after MUCL repair demonstrated suboptimal return to play compared with ulnar collateral ligament reconstruction, prompting a shift toward reconstruction techniques.

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Ulnar collateral ligament injury of the elbow is a problem most associated with baseball pitchers but can be a challenging pathology for any overhead throwing athlete. The prevalence of these injuries has been steadily increasing over the past several decades, as has the need for surgical management. Surgical reconstruction has long been considered the gold standard for complete ulnar collateral ligament injuries in throwers, but repair has surfaced as a viable option for younger patients or those with isolated proximal or distal injuries with good tissue quality.

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The medial ulnar collateral ligament of the elbow is the primary stabilizer against valgus load. It can tear acutely or through attritional damage as in repetitive overhead sports. Although baseball players, particularly pitchers, are the most vulnerable athletes, these injuries also occur in contact athletes, gymnasts, and javelin throwers.

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Article Synopsis
  • The study assesses the return to performance of MLB pitchers after undergoing ulnar collateral ligament (UCL) surgery using advanced analytics and pitch-tracking metrics.
  • At 1, 2, and 3 years post-surgery, the data showed that only 1.6% of pitchers returned to play within the first year, but the rates increased significantly to 71.9% at 2 years and 82.0% at 3 years.
  • The research highlights the importance of modern metrics, examining factors like expected fielding independent pitching and velocity, to evaluate pitchers' recovery and performance levels after surgery.
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