¹McDermott M, ²Santucci E, ³Bennett S, ²Nesterenko A, ¹Byrne N, ¹Romeo A
¹Duly Health and Care, Naperville, IL, USA; ²Franciscan Health, Olympia Fields, USA; ³Kettering Health Dayton, Dayton, USA

Hypothesis
Adding an internal brace (IB) to an ulnar collateral ligament (UCL) reconstruction in tissue deficient UCL tears will allow for a return to throwing and sport for pitchers that is equivalent to pitchers with less severe tears that can be fixed with IB alone.

Methods
A retrospective review was conducted of patients who underwent surgical repair for UCL tears between January 2021-December 2022. Patients included were baseball and softball players who desired to return to the same or higher level of competition following surgery. Patients with tissue deficient UCL tears at the time of surgery underwent UCL Reconstruction (UCLR) with tendon allograft and IB (Figure 1); while those with less severe UCL tissues underwent UCL repair with IB alone. Each patient in this study was followed for a minimum of one year as they pursued a return to their playing careers. For each patient, the time to return to throwing (RTT) and return to sport (RTS) were used to monitor clinical outcomes. Return to sport is defined as began playing in a game again at the pre-operative competition level.

Results
Twenty-two patients underwent UCL repair (High School = 5; Collegiate = 16; MiLB = 1) including 20 baseball and 2 softball players. The average player age was 19.5 ± 2.1 years (range: 15-24yrs). 11 patients underwent a combined UCLR with IB and 11 patients underwent UCL repair with IB alone. An ulnar nerve transposition was performed in 31% of cases. For the entire cohort, the average return to training was for the cohort was 4.2 ± 0.9 months and the average return to games was 10.0 ± 1.6 months, with no difference between UCLR + IB vs UCL IB for either time. Although not statistically significant, 100% of patients in the UCLR + IB group return to sports prior to the 12 months postoperatively mark, compared to 81.8% of patients in the UCL IB group (p = 0.15, Figure 2).

Discussion
The addition of a suture tape internal brace to a UCL reconstruction provides a reliable repair for baseball players with more severe UCL tissue damage; demonstrating a RTT and RTS that is equivalent to patients with less severe injuries that can be repaired with internal bracing alone.