Background: While surgical interventions for ulnar collateral ligament (UCL) injuries in throwing athletes have improved return-to-sport rates, predicting individual recovery timelines and the risk of complications remains a challenge. The influence of a patient's preoperative status, captured through patient-reported outcomes (PROs), on postoperative recovery milestones and complication risks is not well-defined.
Purpose/hypothesis: The purpose of this study was to determine if baseline PROs and specific surgical variables predict critical postoperative milestones and adverse outcomes following UCL surgery. It was hypothesized that better baseline PROs would be associated with improved postoperative outcomes.
Study design: Cohort study: Level of evidence, 3.
Methods: Data for this study were obtained from The Pitch Registry, a multi-institutional database of baseball players with UCL injuries, analysis conducted between 2019 and 2023. Of 506 screened patients, 146 were included based on having ≥2 years of follow-up and complete preoperative PROs. Baseline PROs, including the American Shoulder and Elbow Surgeons (ASES) score, Kerlan-Jobe Orthopaedic Clinic (KJOC) score, and Youth Throwing Score (YTS), were collected. Postoperative outcomes, including time to return to throwing (RTT) and return to mound (RTM), and the presence of surgical complications, were documented. Intraoperative variables, such as the type of UCL procedure (repair or reconstruction), were also recorded.
Results: A total of 146 patients were included for analysis, and their surgical breakdown included 39 (26.7%) repairs, 69 (47.3%) palmaris reconstructions, and 38 (26.0%) gracilis reconstructions. Reported level of play included high school (30%), college (56%), minor league professional (10%), and major league professional (1%). Better baseline total ASES scores were significantly associated with a faster RTT (coefficient -0.09 weeks/point; P = .003) and decreased odds of postoperative complications (odds ratio [OR] 0.97; 95% CI, 0.94-0.99; P = .01). Worse baseline ASES intensity of pain scores significantly predicted longer RTT (coefficient 0.5 weeks/point; P = .01) and increased odds of complications (OR, 1.3; P = .005), revision surgery (OR, 1.3; P = .04), and ulnar nerve symptoms (OR, 1.2; P = .04). The repair group demonstrated significantly shorter RTT (mean, 14.8 weeks) and RTM (mean 31.7 weeks) compared with both palmaris (RTT: 18.9 weeks, P < .001; RTM: 41.7 weeks, P < .001) and gracilis groups (RTT: 22.4 weeks, P < .001; RTM: 42.1 weeks, P < .001). No significant differences were found in complication, reoperation, or ulnar nerve symptom rates among the surgical groups (repair vs palmaris vs gracilis). Other PROs (KJOC, YTS) and surgical variables (ulnar nerve transposition, scope) did not consistently predict these outcomes.
Conclusion: Better baseline PROs, particularly better total ASES scores and better ASES intensity of pain scores, are associated with faster RTT and a reduced risk of postoperative complications and adverse events following UCL surgery. UCL repair was associated with significantly faster RTT and RTM timelines compared to reconstruction with either palmaris or gracilis autografts. These findings suggest that specific preoperative PROs can aid surgeons in managing patient expectations and counseling regarding postoperative recovery.
Keywords: patient-reported outcome; pitching injuries; return to sport; throwing athletes; ulnar collateral ligament.
© The Author(s) 2025.