The Utility of Stress Ultrasound in Identifying Risk Factors for Elbow Ulnar Collateral Ligament Tear: A Longitudinal Study of 203 Professional Baseball Players.

BACKGROUND

Injuries to the medial ulnar collateral ligament (UCL) are common among baseball pitchers due to repetitive stress on the soft tissue stabilizers of the elbow during pitching. Dynamic stress ultrasound (SUS) can be used to evaluate the UCL and ulnohumeral joint to identify anatomic risk factors of those who will require UCL reconstruction (UCLR).

PURPOSE

To determine whether any adaptive or morphological changes detectable on SUS can predict injury to the UCL in professional baseball pitchers.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A total of 203 professional baseball pitchers who underwent SUS at preseason training sessions over the course of 18 years were categorized into 1 of 2 groups: those without a history of shoulder, arm, elbow, or forearm surgery or injuries (healthy cohort; n = 184) and those who underwent UCLR the same season as SUS (UCLR cohort; n = 19). Ligament thickness, joint spacing, and laxity were compared. An additional matched cohort analysis was conducted using 10 players from each group to detect differences in the progression of UCL and ulnohumeral joint measures in the year before injury.

RESULTS

The UCLR cohort, when compared with the healthy cohort, had higher relative (ie, nondominant-side measurements subtracted from dominant-side measurements) resting ulnohumeral joint space (median, 0.50 vs 0.20 mm, respectively;

CONCLUSION

SUS of players who underwent UCLR demonstrated a progressive increase in UCL thickness over 1 year, higher rates of hypoechoic foci, and increased ulnohumeral rest space compared with SUS of uninjured players.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: B.J.E. has received consulting fees from Arthrex and DePuy Synthes Products; research support from Arthrex, DePuy, Linvatec, Smith + Nephew, and Stryker; support for education from Gotham Surgical Solutions & Devices, Smith + Nephew, and Pinnacle Inc; and hospitality payments from Wright Medical Technology, Liberty Surgical, and Stryker. R.A.J. has received consulting fees from Zimmer Biomet Holdings and support for education from Medinc of Texas, Smith + Nephew, and Liberty Surgical. S.B.C. has received research support from Arthrex and Major League Baseball; consulting fees from CONMED Linvatec and Zimmer Biomet Holdings; and support for education from Liberty Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.