Combined flexor-pronator mass and ulnar collateral ligament injuries in the elbows of older baseball players.
BACKGROUND
Ulnar collateral ligament reconstruction techniques have afforded baseball players up to a reported 90% return to prior or higher level of play. A subpopulation exists with less impressive clinical outcomes potentially related to the presence of a concomitant flexor-pronator mass injury.


OBJECTIVE
Combined flexor-pronator and ulnar collateral ligament injuries occur in older players, and results in this group are inferior to those reported for isolated ulnar collateral ligament reconstructions.


METHODS
Case Series; Level of evidence, 4.


METHODS
All baseball players who had ulnar collateral ligament reconstructions by 1 surgeon over a 6-year period were identified, and the authors studied those treated for a combined flexor-pronator and ulnar collateral ligament injury. The ulnar collateral ligament reconstruction was accomplished using the docking technique, and the flexor-pronator injury was treated with debridement if tendinotic or reattachment if torn. A 2-sample t test was conducted to evaluate the likelihood of developing the combined flexor-pronator/ulnar collateral ligament compared with ulnar collateral ligament injury based on age, while a Pearson chi(2) test was used to evaluate the likelihood of a patient being > or =30 years of age in the combined flexor-pronator/ulnar collateral ligament versus ulnar collateral ligament groups. Outcome was assessed using a modified Conway classification.


RESULTS
A total of 187 male baseball players between 14 and 42 years of age (mean, 20.7 years) had an ulnar collateral ligament reconstruction by 1 surgeon. Eight (4%) of 187 baseball players were treated for the combined flexor-pronator/ulnar collateral ligament injury. There was a statistically significant difference in age between the ulnar collateral ligament group (20.1 years) and the flexor-pronator/ulnar collateral ligament group (33.4 years) (P < .001). Age > or =30 years was a statistically significant age limit to predict the presence of a combined flexor-pronator/ulnar collateral ligament injury (88%) compared with an isolated ulnar collateral ligament injury (1%) (P < .001). Outcomes were 1 excellent (12.5%), 2 fair (25%), and 5 poor (62.5%). Conclusion Combined fflexor-pronator and ulnar collateral ligament injuries in baseball players may portend a worse prognosis, with a 12.5% return to prior level of play. Older age (> or =30 years) is a risk factor in the development of this combined injury. When combined flexor-pronator/ulnar collateral ligament injury is suspected preoperatively, patients should be counseled on expected outcomes appropriately.
Hospital for Special Surgery, New York, NY, USA. osbahrd@hss.edu
Daryl C
DC
Osbahr
Swarup S
SS
Swaminathan
Answorth A
AA
Allen
Joshua S
JS
Dines
Struan H
SH
Coleman
David W
DW
Altchek
D000293:Adolescent; D000328:Adult; D001484:Baseball / Q000293:injuries*; D017885:Collateral Ligaments / Q000293:injuries* / Q000601:surgery*; D003646:Debridement; D004550:Elbow / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult; D000092464:Elbow Injuries