Non-operative Treatment of UCL Injury Can Be Effective in Some Professional Baseball Players

Professional baseball players with a low-grade ulnar collateral ligament (UCL) injury that occurs on the humeral side of the elbow have a better chance of returning to throw (RTT) and returning to play (RTP) and are less likely to require UCL surgery than players with more severe injuries on the ulnar side of the elbow, according to a study presented at the 2019 Annual Meeting of the American Orthopedic Society of Sports Medicine.

The researchers identified 544 professional baseball players from the MLB Health and Injury Tracking System who were treated non-operatively for UCL injuries between 2011 and 2015. The average age of these players was 22.5 years, with 90% percent playing minor league baseball and 84% being pitchers.

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An independent, experienced musculoskeletal radiologist reviewed the elbow MRIs available for 237 players, grading the tears and noting their location.

  • Grade: 36% Grade 1 (edema), 49% Grade II (partial tear), 15% Grade III (complete tear)
  • Location: 65% humeral side, 13% ulnar side, 22% both-sided

The researchers used this data to evaluate the relationship of MRI tear grade and injury location with outcomes. They also recorded each player’s RTT, RTP, and need for UCL reconstruction after non-operative therapy.

They found no statistically significant differences in RTT, RTP, and UCL reconstruction by grade or tear location. However, objectively, ulnar-sided tears had the lowest RTT and RTP rates (81% and 42%, respectively). Players with ulnar and both-sided tears also had a higher rate of UCL reconstruction (58% and 60%, respectively) compared with players with humeral-side tears (51%; P=0.441).

In addition, the researchers’ analysis found that players over age 25 had a lower RTP than players age 25 and younger, and major league players were more likely to suffer re-injury or need UCL reconstruction than minor league players.

“This is the largest study to evaluate the prognostic relationship of MRI injury grade and tear location with outcomes for non-operatively treated elbow UCL tears in professional baseball players,” said lead author Aakash Chauhan, MD, MBA, from Dupage Medical Group in Naperville, Illinois.

“Based on this study, non-operative treatment of ulnar collateral ligament injuries will likely be more successful in younger players, lower-grade tears, and humeral-sided injuries.”


Chauhan A, Chalmers PN, McQueen PD, et al. Outcomes of Non-Operatively Treated Elbow Ulnar Collateral Ligament Injuries in Professional Baseball Players by Magnetic Resonance Imaging Tear Grade and Location (Paper 66). Presented at the 2019 Annual Meeting of the American Orthopedic Society of Sports Medicine, July 11-14, 2019, Boston, Massachusetts.

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