Return to Sport Criteria and Outcomes in Javelin Athletes Following Ulnar Collateral Ligament Reconstruction: a Systematic Review.

Background: Ulnar collateral ligament (UCL) injuries are common among javelin throwers and surgical intervention is the preferred treatment method. Universally accepted javelin-specific return-to-sport (RTS) guidelines would benefit healthcare providers in returning athletes safely to the sport.

Purpose: To systematically assess the current literature for RTS criteria and identify gaps and opportunities for developing javelin-specific return to throwing (RTT) and RTS recommendations.

Study design: Systematic review.

Methods: A Boolean search related to javelin, UCL surgery, RTS was performed using PubMed/Medline, ProQuest, PEDro, Scopus, CINAHL, Cochrane, EMBASE, and SPORTDiscus databases. Studies published between 2000, and May 2024 were included if they had a population of javelin athletes of any level of competition who underwent UCL reconstruction (UCLR) with a minimum follow-up of one year.

Results: Four studies met inclusion criteria for this review with a total population of 34 athletes (mean age, all studies: 19.7 years) and an average follow-up period of 3.8 years for all studies. Of the 34 athletes, 82% returned to any level of play at an average of 11.2 months post-surgery, with 70.1% returning to their previous level of competition. Only one study provided a specific RTT program, which included stepwise progressions for number, effort, quality, and distance for throws and javelin weights used for each program phase.

Conclusion: This review found no studies providing guidelines for RTT/RTS criteria for javelin athletes following UCLR that emphasized objective measures of rehabilitation progress and completion. Further research on post-surgical physical function and subsequent programming tailored to the demands of javelin athletes is needed to guide safe return to sport.

Level of evidence: 3a.