Retrospective Clinical Outcomes of Ulnar Collateral Ligament Reconstruction in the Setting of an Ossified Ulnar Collateral Ligament.

Background: The ulnar collateral ligament (UCL) plays a vital role in maintaining the stability of the elbow joint during overhead throwing activities. Stress to the UCL may lead to high-grade or full-thickness tears that require reconstruction or repair and lengthy rehabilitation in athletes. Workup of these injuries can sometimes reveal ossification in the ligament. It is unknown if ossification in the UCL affects postoperative outcomes.

Purpose/hypothesis: The purpose of this study was to investigate whether different preoperative ossification conditions of the UCL might influence various clinical and return-to-play (RTP) outcomes in athletes undergoing UCL reconstruction (UCLR). It was hypothesized that patients with preoperative ossification conditions in the UCL who underwent reconstruction would experience comparable rates of RTP and level of competition compared with all players undergoing UCLR.

Study design: Case series; Level of evidence, 4.

Methods: An internal search was conducted to identify all cases of UCLR performed by 3 participating surgeons at the Andrews Institute between 2007 and 2022. Patients who had undergone primary UCLR and showed radiographic evidence of UCL ossification were included for analysis if they were ≥2 years after reconstruction. Retrospective chart reviews were performed for all included patients, and their radiographs were categorized by location of ossification. Differences in age, level of play, range of motion, and RTP status between patients with different ossification types were evaluated.

Results: Between August 2007 and December 2022, 386 patients who underwent UCLR at the Andrews Institute were identified. Among these patients, 26% (n = 100) were found to have ossified UCLs. However, only 79 of these patients had complete medical records and were included in the analysis. Among the 79 athletes in this study with ossified ligaments, 71 (90%) who underwent UCLR returned to competitive sports. Athletes exhibited various classification conditions, including heavily calcified ligaments, calcified sublime tubercles, and humeral and/or ulnar-sided ossicles. No differences were found in the level of competitive RTP among the ossification groups.

Conclusion: RTP rates in athletes with ossified ligaments are high and comparable with those in the literature across all ossification conditions.