title: Epidemiology of Medial Ulnar Collateral Ligament Reconstruction: A 10-Year Study in New York State.
abstract: BACKGROUND
  Despite an increase in the prevalence of medial ulnar collateral ligament (UCL) reconstruction of the elbow in professional baseball and popularity within the media, there are no population-based studies examining the incidence of UCL reconstruction.
  
  
  OBJECTIVE
  To examine the epidemiological trends of UCL reconstruction on a statewide level over a 10-year period. The primary endpoint was the yearly rate of UCL reconstruction over time; secondary endpoints included patient demographics, institution volumes, and concomitant procedures on the ulnar nerve.
  
  
  METHODS
  Descriptive epidemiology study.
  
  
  METHODS
  The New York Statewide Planning and Research Cooperative System (SPARCS) database contains records for each ambulatory discharge in New York State. This database was used to identify all UCL reconstructions in New York State from 2002 to 2011 using the outpatient CPT-4 (Current Procedural Terminology, 4th Revision) code. Assessed were patient age, sex, ethnicity, insurance status, and associated procedures, as well as hospital volume.
  
  
  RESULTS
  There was a significant yearly increase in the number of UCL reconstructions (P < .001) performed in New York State from 2002 to 2011. The volume of UCL reconstructions increased by 193%, and the rate per 100,000 population tripled from 0.15 to 0.45. The mean ± SD age was 21.6 ± 8.89 years, and there was a significant trend for an increased frequency in UCL reconstruction in patients aged 17 to 18 and 19 to 20 years (P < .001). Male patients were 11.8 times more likely to have a UCL reconstruction than female patients (P < .001), and individuals with private insurance were 25 times more likely to have a UCL reconstruction than those with Medicaid (P = .0014). There was a 400% increase in concomitant ulnar nerve release/transposition performed over time in the study period, representing a significant increase in the frequency of ulnar nerve procedures at the time of UCL reconstruction (P < .001).
  
  
  CONCLUSIONS
  The frequency of UCL reconstruction is steadily rising in New York State and becoming more common in adolescent athletes. Emphasis on public education on the risks of overuse throwing injuries and the importance of adhering to preventative guidelines is essential in youth baseball today.
authors.affiliation: Center for Shoulder, Elbow, and Sports Medicine, Columbia University Medical Center, New York, New York, USA.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Hodgins
authors.affiliation: ONS Foundation for Clinical Research and Education, Greenwich Hospital, Yale-New Haven Health, Greenwich, Connecticut, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Vitale
authors.affiliation: Center for Shoulder, Elbow, and Sports Medicine, Columbia University Medical Center, New York, New York, USA.
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Arons
authors.affiliation: Center for Shoulder, Elbow, and Sports Medicine, Columbia University Medical Center, New York, New York, USA csa4@cumc.columbia.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes / Q000706:statistics & numerical data*; D001484:Baseball / Q000293:injuries; D017885:Collateral Ligaments / Q000601:surgery*; D012090:Cumulative Trauma Disorders / Q000601:surgery; D016208:Databases, Factual; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D000068958:Return to Sport / Q000706:statistics & numerical data*; D000070599:Shoulder Injuries; D014457:Ulna / Q000601:surgery*; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Tommy John surgery; incidence; overhead athlete; ulnar collateral ligament (UCL) reconstruction