title: Symptomatic Heterotopic Ossification After Ulnar Collateral Ligament Reconstruction: Clinical Significance and Treatment Outcome.
abstract: Ulnar collateral ligament (UCL) reconstruction is an increasingly common procedure being performed in overhead throwing athletes. Recently, postoperative imaging has revealed the presence of heterotopic ossification (HO) in symptomatic patients.
  
  
  
  To determine the incidence of symptomatic HO after UCL reconstruction as well as the clinical outcomes after nonoperative or operative treatment of HO.
  
  
  
  Case series, Level of evidence, 4.
  
  
  
  A search was performed of diagnostic codes for all UCL reconstructions at a single institution between 2002 and 2012, and the charts were then reviewed of patients who returned to clinic for symptomatic HO after UCL reconstruction. All relevant clinical information, imaging findings, and return-to-play data were obtained.
  
  
  
  Eight patients were found to have developed symptomatic HO after UCL reconstruction. Of the 8 patients, 6 had gracilis tendon autograft at their primary surgery. All 8 patients had HO on the proximal end of their graft. Two patients were treated nonoperatively, and the remainder had excision of HO performed either arthroscopically or open. Six patients were able to return to the same or higher level of competition after treatment of HO.
  
  
  
  Symptomatic HO after UCL reconstruction is very uncommon but may prove to be a significant complication among athletes. With appropriate treatment, the majority of patients were able to return to the same level of play. Early identification of this complication is important, as revision surgery with excision of osteophytes resulted in a return to a similar level of play in most patients.
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Andrachuk
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences, South Orange, New Jersey, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Scillia
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: Kyle T
authors.initials: KT
authors.lastname: Aune
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Andrews
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Dugas
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA lyle.cain@andrewscenters.com.
authors.forename: E Lyle
authors.initials: EL
authors.lastname: Cain
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000601:surgery*; D001484:Baseball / Q000293:injuries*; D006801:Humans; D015994:Incidence; D009999:Ossification, Heterotopic / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D014182:Transplantation, Autologous / Q000009:adverse effects; D016896:Treatment Outcome; D000070638:Ulnar Collateral Ligament Reconstruction / Q000009:adverse effects*; D055815:Young Adult
keywords: Tommy John surgery; complications; elbow; outcomes; ulnar collateral ligament reconstruction