2015 ISAKOS Biennial Congress Paper #0

Does Prehabilitation Prior to Ulnar Collateral Ligament Surgery Affect Return to Sport Rate or Time in Baseball Pitchers with Partial UCL Tears?

Kourtney Snigar, MS, Philadelphia UNITED STATES
Ryan W. Paul, BS, Nutley, NJ UNITED STATES
Joshua Spada, DPT, Stratford UNITED STATES
Usman Zareef, BA, Piscataway, NJ UNITED STATES
Anya Hall, BS, Egg Harbor Township UNITED STATES
Brandon Erickson, MD, New York, NY UNITED STATES
Michael G. Ciccotti, MD, Philadelphia, PA UNITED STATES
Stephen J Thomas, PhD, ATC, Philadelphia, PA UNITED STATES
Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, UNITED STATES

FDA Status Not Applicable

Summary: Baseball players who attempt rehabilitation prior to UCL surgery have similar post-operative outcomes compared to baseball players who do not attempt rehabilitation prior to surgery.

Abstract:

Background

The benefits of prehabilitation have been studied and implemented for ACL surgery, but have not been evaluated for UCL surgery. Therefore, the purpose of this study was to determine whether baseball players with partial UCL tears who completed at least 4 weeks of prehabilitation prior to surgery (Prehab) had better post-operative outcomes and quicker return to sport (RTS) time than players who attempted 0-3 weeks of physical therapy prior to UCL surgery (No Prehab).

Methods

Baseball players of all competitive levels who underwent primary UCL reconstruction (UCLR) or UCL repair for partial-thickness UCL tears from 2010-2019 were included. Physician chart notes and operative notes were screened to identify whether preoperative conservative treatment was attempted. Patients were contacted via RedCap to collect postoperative outcomes (reoperation, revision, complications) and patient-reported outcomes (RTS, Kerlan-Jobe Orthopaedic Clinic [KJOC] score, Andrews-Timmermann score, satisfaction).

Results

Overall, 105 baseball pitchers were included (50 Prehab vs. 55 No Prehab) followed up at 3.4 ± 2.5 years postoperatively. Six pitchers underwent UCL repair, and 99 pitchers underwent UCLR. All demographics were similar between groups except the Prehab group more frequently received a gracilis graft (77% vs. 51%, p=0.038). RTP rate (Prehab: 88.1% vs. No Prehab: 93.8%, p=0.465) and RTP duration (12.8 ± 5.2 months vs. 14.0 ± 4.1 months, p=0.307) were similar between groups. All other postoperative outcomes were also similar between groups, including revision rates and patient-reported outcomes.

Conclusions

Baseball players who attempt rehabilitation prior to UCL surgery have similar post-operative outcomes compared to baseball players who do not attempt rehabilitation prior to surgery. Purposeful prehabilitation may not be necessary in baseball players undergoing operative UCLR/UCL repair; however, rehabilitation still plays an important role in players who may succeed without surgery.