Baseball UCL Surgery and Recovery

What does baseball UCL surgery look like and what is the UCL surgery recovery process? ASMI has a great Masterclass on ulnar collateral ligament (UCL) surgery, rehab and post-operative biomechanics featuring top surgeons, physical therapists and researchers. If your child is at risk for an arm injury, which is pretty much every baseball pitchers, this is definitely worth listening to even if you skip the first 27 minutes of detail about the surgery. See the notes below for the key points from each presentation as well as the Q&A

The Why and How of UCL Construction and Repair beginning presented by Jeffrey Dugas (6:10)

Post-operative Rehab presented by Kevin Wilk (27:34)

  • 60% youth and 40% adult (30:20)
  • 15-19 year olds are at highest risk (30:40)
  • Youth risk factors (33:20)

Interval Throwing Program presented by Mike Reinhold (46:15)

  • Acute chronic workload ratio over 1.3 increases injury risk 15x (40:20)
  • Elbow stress by long-toss distance (54:25)
  • Newly revised interval throwing program (56:20)

Pitching Biomechanics After UCL Surgery presented by Glenn Fleisig (1:04:10)

  • Very similar levels of biomechanics post-surgery (1:09:35)
  • 70-80% of UCL reconstructions return to previous levels and 97% of UCL repairs return to previous levels (1:11:30)

Q&A (1:12:0)

  • What’s been the biggest change in the treatment of UCL injuries in the recent decades (1:12:20): It used to be professionals. Now it’s primarily youth. Internal bracing has been the key change. Younger group feels the injury earlier than professionals. Average age is 19
  • What the biggest challenge in getting patients to buy into the time it takes for rehab (1:15:15): Time is long. Usually starts at four months. It’s a marathon. Have to get players to buy into a slow throwing program
  • Is the timing for the throwing program flexible or can it be accelerated (1:16:45): Should have a standard and decelerated time. There’s no reason to rush it
  • Dr. Andrews on showcases (1:20:10): Showcases are in the top five reasons for injuries in youth baseball. They’re crazy. We need to deemphasize their important. They’re nothing but trouble makers
  • Should radar guns be used to monitor recovery (1:21:45): They can be useful as long as players aren’t trying to max them out. An alternative is the Motus sleeve to monitor workload. 50% effort throw is about 75% mph. 75% effort throw is about 90% of mph. Another study showed 60% effort equaled about 80% velocity
  • What are some pitfalls of UCL repair becoming more common (1:25:45): Can do more damage with the repair if don’t really understand reconstruction. Can make it too tight. It requires more precision
  • What are biggest risk factors (1:31:00): Fatigue and velocity. Each ligament is different and can’t withstand the same stress. High school pitchers who throw from 80-85 mph are at greater risk. Fatigue, full effort pitching and and pitching year round lead to microscopic problems in your elbow. 250 feet plus long-toss, weighted ball are going to create fatigue much faster and causing many injuries. The potential for increased velocity isn’t worth the risk of increase injury, but that’s the problem in youth baseball

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