Does Well Maintained Graft Provide Consistent Return to Play after Medial Ulnar Collateral Ligament Reconstruction of the Elbow Joint in Elite Baseball Players?

The medial ulnar collateral ligament (MUCL) of the elbow is primary static constraint of the ulnohumeral joint to valgus force.1,2) The anterior bundle of the MUCL is the major stabilizing structure of the elbow.3,4) Repeated throwing can lead to microtrauma or rupture of the MUCL.5) The injuries to MUCL of the elbow are most common in the overhead athletes, particularly the baseball players.2,4,6,7,8,9,10) The players with partial tears of the MUCL may return to play after proper rehabilitation. However, those with complete tears, which induce considerable valgus laxity or persistent medial elbow pain, need to have the operation in order to return to sports activities. Several studies have reported outcomes regarding returning to the preinjury level after MUCL reconstruction, in the throwing athletes. In 1986, Jobe et al.11) firstly described a MUCL reconstruction, reporting 62.5% of return rate in the overhead athletes. The return rates reported in the recent clinical studies vary from 33% to 92%.4,6,12,13,14,15,16) One of the probable reasons for the inconsistent return rate is the innate drawback of the figure eight technique. The previous article reported that the disadvantage of MUCL reconstruction, using figure of eight technique, was difficult to maintain tension because of the high number of holes in medial epicondyle.17) However, as far as we are aware, no study has evaluated on the integrity of the incorporated grafts, which would validate the success of the surgical treatment. The aim of this study is to report the clinical and image outcomes after MUCL reconstruction, using the figure of eight fashion in high school and elite baseball players. The primary measure for the outcomes was the graft integrity evaluated with ultrasonography, and the secondary measures for the outcomes were postoperative pain, range of motion (ROM), and the Conway scale.