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The Severity of Ulnar Collateral Ligament Injuries of the Elbow in Overhead versus Non-Overhead Athletes in National Collegiate Athletic Association Sports from 2009-2010 through 2013-2014
Neill Yun Li, MD; Steven F DeFroda, MD, MEng; Avi D Goodman, MD; Brett Owens, MD
Brown University, Providence, RI

INTRODUCTION: Ulnar collateral ligament (UCL) injuries of the elbow frequently occur in overhead athletes. However, the severity of these injuries in both overhead and non-overhead athletes have not been well described. Utilizing a national database of collegiate athlete injuries, an analysis of UCL injuries in both non-overhead and overhead athletes was performed.

MATERIALS&METHODS: UCL injuries of the elbow and athlete exposures were collected from the National Collegiate Athletic Association (NCAA) Injury Surveillance System from 2009-2010 through 2013-2014. Sport, sex, mechanism, event type, time loss, and outcome (e.g. season-ending, requiring surgery) were recorded. Comparison of overhead and non-overhead athletes were separated by throwing and non-throwing sports. Based off previous studies, severe injuries were loss of 21 days or an end to the season. Incidence per 10,000 athlete-exposures (AEs) and rate ratios (RRs) of UCL injuries were conducted with 95% CIs and weighted to national estimates of annual incidence for each sport of occurrence.

RESULTS: A total of 5528 ulnar collateral injuries occurred over 3,050,988 athlete exposures between the 2009-2010 to 2014-2015 seasons for an incidence of 0.42 injuries per 10,000AEs. The incidence of severe UCL injuries was greatest in men's wrestling (0.47/10,000AEs) and men's baseball (0.44/10,000AEs). Severe UCL injuries occurred more in practice than competition (RR: 1.5, 95% CI: 0.59-3.95) with male athletes sustaining more severe injuries than female athletes (RR: 1.78, 95% CI: 0.68-4.63). Throwing accounted for 76.6% of severe injuries (0.24/10,000AEs) with the remaining from contact (0.082/10,000AEs) resulting in a higher rate of severe UCL injury (RR: 2.6, 95% CI: 1.14-5.81) than contact. Overhead athletes had a significantly higher rate of severe UCL injuries than non-overhead athletes (RR: 2.59, 95%CI: 1.08, 6.23). Overhead athletes also sustained a higher season ending injury rate (RR: 1.59, 95%CI: 0.52-4.86) and surgery rate (RR: 1.54, 95%CI: 0.16-14.8) than non-overhead athletes. Athletes that underwent surgery were men's baseball (n=256.6, 0.18/10,000AEs) and men's wrestling (n=33.6, 0.12/10,000AEs).

CONCLUSIONS: Athletes requiring repetitive overhead actions are prone to severe UCL injuries resulting in a poor prognosis for subsequent play. However, severe UCL injuries also occur at a high incidence in non-overhead sports as a result of falling, blocking, or tackling. The prognosis for return to activity of non-overhead athletes following severe UCL injuries are improved compared to overhead athletes. Thus, both overhead and non-overhead athletes are at risk for severe UCL injury warranting further discussion of the most appropriate management of elbow UCL injury prevention and protection.

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