Does posteromedial chondromalacia reduce rate of return to play after ulnar collateral ligament reconstruction?
BACKGROUND
Biomechanical studies suggest ulnohumeral chondral and ligamentous overload (UCLO) explains the development of posteromedial chondromalacia (PMC) in throwing athletes with ulnar collateral ligament (UCL) insufficiency. UCL reconstruction reportedly allows 90% of baseball players to return to prior or a higher level of play; however, players with concomitant posteromedial chondromalacia may experience lower rates of return to play.


OBJECTIVE
The purpose of this investigation is to determine: (1) the rates of return to play of baseball players undergoing UCL reconstruction and posteromedial chondromalacia; and (2) the complications occurring after UCL reconstruction in the setting of posteromedial chondromalacia.


METHODS
We retrospectively reviewed 29 of 161 (18%) baseball players who were treated for the combined posteromedial chondromalacia and UCL injury. UCL reconstruction was accomplished with the docking technique, and the PMC was addressed with nothing or débridement if Grade 2 or 3 and with débridement or microfracture if Grade 4. The mean age was 19.6 years (range, 16-23 years). Most players were college athletes (76%) and pitchers (93%). We used a modified four-level scale of Conway et al. to assess return to play with 1 being the highest level (return to preinjury level of competition or performance for at least one season after UCL reconstruction). The minimum followup was 24 months (mean, 37 months; range, 24-52 months).


RESULTS
Return to play was Level 1 in 22 patients (76%), Level 2 in four patients (14%), Level 3 in two patients (7%), and Level 4 in one (3%) patient.


CONCLUSIONS
Our data suggest baseball players with concomitant PMC, may have lower rates of return to the same or a higher level of play compared with historical controls.


METHODS
Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
Hospital for Special Surgery, New York, NY, USA.
Daryl C
DC
Osbahr
Joshua S
JS
Dines
Andrew J
AJ
Rosenbaum
Joseph T
JT
Nguyen
David W
DW
Altchek
D000293:Adolescent; D000328:Adult; D054544:Arthroplasty, Subchondral; D001182:Arthroscopy; D001484:Baseball / Q000293:injuries*; D002357:Cartilage Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002358:Cartilage, Articular / Q000473:pathology / Q000601:surgery; D017885:Collateral Ligaments / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D012090:Cumulative Trauma Disorders / Q000175:diagnosis / Q000601:surgery*; D003646:Debridement; D004551:Elbow Joint / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D019651:Plastic Surgery Procedures / Q000379:methods; D055815:Young Adult