Overuse injuries to the elbow in the throwing athlete are frequent. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on athletes from all levels of competition. The purpose of this study is to review all ulnar collateral ligament reconstructions performed at a single institution between January 2004 – July 2014. The study reported patient demographics, clinical outcomes, return to sport rate and complications.

1. UCLR:TheRushExperience
Ulnar Collateral Ligament Reconstruction:
The Rush Experience
Brandon J. Erickson MD, Bernard R. Bach Jr. MD, Mark S
Cohen, Charles A. Bush-Joseph MD, Brian J. Cole, Nikhil N.
Verma, Gregory P. Nicholson, and Anthony A. Romeo MD

2. UCLR:TheRushExperience Disclosures
• No relevant disclosures.
• Funding sources:
– KFx Medical
– AANA
– Accelerated Rehabilitation Centers Ltd.
– MAOA
I (and/or my co-authors) have
something to disclose.
Detailed disclosure information is available via:
“My Academy” app;
Printed Final Program; or
AAOS Orthopaedic Disclosure Program on the AAOS website at
http://www.aaos.org/disclosure
My Academy

3. UCLR:TheRushExperience
INTRODUCTION
Overuse injuries to the elbow in the throwing athlete are
frequent. Ulnar collateral ligament reconstruction (UCLR),
commonly known as Tommy John surgery, is performed
on athletes from all levels of competition.

4. UCLR:TheRushExperience
PURPOSES
• Review all UCLR performed at a single
institution between January 2004 – July 2014
• Report:
• Patient Demographics
• Clinical Outcomes
• Return to Sport Rate
• Complications

5. UCLR:TheRushExperience
HYPOTHESES
1. There will be a significant increase in the number of
UCLR performed over time
1. Return to sports rates would be >80%

6. UCLR:TheRushExperience
METHODS
• Surgical database of a single group practice was
reviewed from January 1st 2004-July 1st 2014
• Current procedural terminology (CPT) for UCLR, 24346,
was used to search the database
• 187 patients (188 elbows)

7. UCLR:TheRushExperience
METHODS
• Electronic charts were reviewed for all patients to
determine:
• Patient age
• Sex
• Hand dominance
• Presence or absence of pre-op ulnar nerve sx
• Physical exam findings
• Prior elbow surgeries
• Traumatic or atraumatic injury
• Sport played (if any)
• Level of sport played (high school, collegiate, professional,
recreational)
• Surgical technique
• Whether a concomitant arthroscopy and/or ulnar nerve
transposition was performed
• Graft type
• Complications

8. UCLR:TheRushExperience
METHODS
• Patients with working phone numbers on file who were
more than 18 months out from surgery were then
contacted by the lead author via phone calls
• Patients were asked about
• Ability or inability to return to sport
• Function on return to sport (same, better, or worse)
• Any complications they experienced
• Conway-Jobe score
• Timmerman & Andrews score
• Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder
and Elbow score

9. UCLR:TheRushExperience

10. UCLR:TheRushExperience
RESULTS
0
5
10
15
20
25
30
35
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
NumberofUCLR
Year
P=0.0017

11. UCLR:TheRushExperience
RESULTS
0
5
10
15
20
25
30
35
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
AveragePatientAge
Year
P=0.83

12. UCLR:TheRushExperience
RESULTS
0
10
20
30
40
50
60
1 2 3 4
NumberofUCLR
Yearly Quarter

13. UCLR:TheRushExperience
Middle School
Athlete at time
of surgery?
High School
Athlete at time
of surgery?
College Athlete
at time of
surgery?
Professional
Athlete at time
of surgery?
Recreational
Athlete at time
of Surgery
Number of
1 68 97 7 15
Patients
Results
Baseball
Player?
(former or
current)
Pitcher?
Non-
Pitcher
Softball
Player?
MLB
Player?
Volleyball
Player?
Football
Player?
Gymnast?
Number of
165 155 10 4 7 2 6 4
Patients

14. UCLR:TheRushExperience
Results
Graft
Choice
Ipsilateral
Palmaris
Autograft
Contralateral
Palmaris
Autograft
Hamstring
Autograft
Triceps
Autograft
Palmaris
Allograft
Hamstring
Allograft
Number of
Patients
111 2 48 2 2 24
Yes No
Ulnar Nerve
Transposed?
79 108

15. UCLR:TheRushExperience
Results
Sport Return to Previous Level? Andrews & Timmerman KJOC
Baseball 94.70% 92.8 +/- 6.8 90.8 +/- 5.8
Baseball Pitcher 92.10% 92.8 +/- 6.8 90.5 +/- 5.8
Baseball Non-Pitcher 100% 95 +/- 7.1 94.5 +/- 2.1
Softball 100% 95 +/- 7.1 90.7 +/- 0.9
Gymnastics 50% 87.5 +/- 3.5 76.3 +/- 24.5
Football 100% 100 92
Cheerleader 100% 85 94.7

16. UCLR:TheRushExperience
Complications
• 5.3% (10/187) of patients underwent subsequent surgeries
• Removal of the cortical fixation button (1 patient)
• Subsequent ulnar nerve transposition (7 patients)
• Elbow arthroscopy for loss of motion (1 patient)
• Revision UCLR (1 patient)

17. UCLR:TheRushExperience
LIMITATIONS
• No pre-operative scores
• KJOC score is not validated for phone use yet
• Could not contact all patients for outcome data
• No physical exam was performed (ROM, strength, etc.)

18. UCLR:TheRushExperience
CONCLUSIONS
1. UCLR was performed most commonly on
collegiate athletes using an ipsilateral
palmaris longus graft
2. Both the standard and double docking
techniques are viable surgical techniques
when performing an UCLR
1. Overall 94.1% of patients who underwent
UCLR were able to return to sport with an
average KJOC score of 90.4 and Timmerman
Andrews Score of 92.5

19. UCLR:TheRushExperience
Thank You