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Epidemiology of Medial Ulnar Collateral Ligament Reconstruction: A 10-Year Study of New York State
Justin L. Hodgins, MD1; Mark A. Vitale, MD, MPH2; Ray Arons, DrPH, MPH1; Evan O'Donnell, MD1; Christopher A. Ahmad, MD1
1Columbia-Presbyterian Medical Center, New York, NY; 2ONS Foundation for Clinical Research and Education, Greenwich, CT

Background: Despite an increase in the prevalence of medial ulnar collateral ligament (UCL) reconstructionof the elbow in professional baseball and popularity within the media, there are no population-based studies examining the incidence of UCL reconstruction.
Purpose: 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 and secondary endpoints included patient demographics, institution volumes and concomitant procedures on the ulnar nerve.
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, Fourth Revision) code. Patient age, sex, ethnicity, insurance status, associated procedures and hospital volume were assessed.
Results: There was a significant yearly increase in the number of UCL reconstructions (p < 0.001) 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 age was 21.6 years (SD 8.89) and there was a significant trend for an increased frequency in UCL reconstruction in 17-18 and 19-20 year-olds (p < 0.001). Males were 11.8 times more likely to have a UCL reconstruction than women (p < 0.001) and individuals with private insurance were 25 times more likely to have a UCL reconstruction than those with Medicaid (p = 0.0014). 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 < 0.001).
Conclusion: 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.


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