title: Trends in Medial Ulnar Collateral Ligament Reconstruction in the United States: A Retrospective Review of a Large Private-Payer Database From 2007 to 2011.
abstract: BACKGROUND
  Overuse injuries to the elbow in the throwing athlete are common. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on both recreational and high-level athletes. There is no current literature regarding the incidence and demographic distribution of this surgical procedure in relation to patient age, location within the Unites States, and sex.
  
  
  OBJECTIVE
  To determine the current demographic distribution of UCLR within the US population included in the PearlDiver database.
  
  
  METHODS
  Descriptive epidemiology study.
  
  
  METHODS
  A retrospective analysis of the PearlDiver supercomputer database, a private-payer database, was performed to identify UCLR procedures performed between 2007 and 2011. The Current Procedural Terminology (CPT) code 24346 (reconstruction of the ulnar collateral ligament of the elbow with the use of a tendinous graft) was used.
  
  
  RESULTS
  Between 2007 and 2011, a total of 790 patients underwent UCLR. The average (±SD) annual incidence was 3.96 ± 0.38 per 100,000 patients for the overall population but was 22 ± 3.4 for patients aged 15 to 19 years. The overall average annual growth was 4.2%. There were 695 males and 95 females. The 15- to 19-year-old patients accounted for significantly more procedures than any other age group (56.8%; P < .001), followed by 20- to 24-year-olds (22.2%). The incidence of UCLR in the 15- to 19-year-old group increased at an average rate of 9.12% per year (P = .009). Significantly more UCLR procedures were performed in the southern United States than in any other region (P < .001). The number of procedures significantly increased over time (P = .039).
  
  
  CONCLUSIONS
  According to this database of a privately insured population, UCLR was performed significantly more in patients aged 15 to 19 than any other age group. The average annual incidence of UCLR per 100,000 people for patients aged 15 to 19 was 22 ± 3.4. Further, this database showed that the number of UCLR procedures is increasing over time. Further work should address risk reduction efforts in this at-risk population.
authors.affiliation: Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. berickso.24@gmail.com.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Erickson
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: Benedict U
authors.initials: BU
authors.lastname: Nwachukwu
authors.affiliation: Holy Cross Hospital Orthopaedic Institute, Fort Lauderdale, Florida, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Rosas
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Schairer
authors.affiliation: Holy Cross Hospital Orthopaedic Institute, Fort Lauderdale, Florida, USA.
authors.forename: Frank M
authors.initials: FM
authors.lastname: McCormick
authors.affiliation: Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bach
authors.affiliation: Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Bush-Joseph
authors.affiliation: Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D002648:Child; D017885:Collateral Ligaments / Q000601:surgery*; D012090:Cumulative Trauma Disorders / Q000601:surgery*; D016208:Databases, Factual; D004550:Elbow / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013710:Tendons; D014481:United States; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Tommy John; United States; elbow; epidemiology; incidence; pitcher; ulnar collateral ligament (UCL) reconstruction