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Disproportionate trends in ulnar collateral ligament reconstruction: projections through 2025 and a literature review

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Background

Medial ulnar collateral ligament (UCL) injuries of the elbow that require surgical management are uncommon. There is growing evidence, however, suggesting that the incidence of UCL reconstruction (UCLR) procedures is rapidly increasing. We sought to quantify the incidence of age-related trends for UCLR from 2003 to 2014 and subsequently to project future trends through 2025. We hypothesized that as the total number of UCLRs performed increased, a disproportionate incidence among younger patients would be observed.

Methods

New York State's Statewide Planning and Research Cooperative System database was queried from 2003 to 2014 to identify individuals between 10 and 40 years old undergoing UCLR. Poisson regression was used to develop future projections for UCLR and New York State population through 2025, and incidence estimates per 100,000 people were calculated.

Results

In New York State between 2003 and 2014, there were 890 patients who underwent UCLR, with average annual incidence per 100,000 people equaling 6.3 ± 2.8 for ages 15 to 19 years, significantly greater than for all other age groups (P < .001). Projections from 2015 through 2025 suggest that incidence in 15- to 19-year-olds and 20- to 24-year-olds will continue to rapidly increase while rates for other age groups will remain relatively stable.

Conclusions

The number of UCLRs performed between 2003 and 2014 increased by 343%, and a disproportionate trend in average annual incidence for patients between 15 and 19 years old was observed. As our review of the literature questioned outcomes in adolescent athletes after UCLR, continued attempts at preventing these injuries in the young throwing athlete remain paramount.

Section snippets

Methods

We used the Statewide Planning and Research Cooperative System (SPARCS) database to examine incidence and trends in UCLR in New York State. The SPARCS database was established by the New York State Department of Health in 1979. The passage of the New York State Public Health Law in 1986 mandated all nonfederal, licensed hospitals to report patient discharges from their facilities. Subsequent regulations expanded reporting requirements to include freestanding, licensed ambulatory surgery

Results

Between 2003 and 2014, 890 patients underwent UCLR in New York State. The majority of patients were male (95.0%), and mean age of the patients was 19.7 ± 4.3 years, with no age-related differences observed between genders (male: 19.8 ± 4.2 years; female: 18.8 ± 5.4 years; P = .130). Minimum age of the patients was 12 years, whereas maximum was 40 years (Table I).

Patients aged 15 to 19 years (56.6%) comprised the majority of UCLR procedures (P < .001), whereas 20- to 24-year-olds comprised 31.9%

Discussion

Our study quantifies the rising incidence of UCLR within the general population during a 12-year period of observation. In addition, to our knowledge, we are the first to provide projections of future trends in UCLR incidence. Our finding of a 343% increase between 2003 and 2014 in the number of UCLRs performed is in keeping with previous literature that reported a 22-fold increase in UCLRs performed between 1994 and 2010.17 In addition, we found that the largest increases in incidence rates

Conclusion

The number of UCLRs performed increased 343% between 2003 and 2014, with the AAI per 100,000 people highest in the 15- to 19-year age group compared with all other ages. Projections to 2025 suggest that this age-related disparity will persist and widen. Results from our review of the literature are equivocal regarding return to sport and advancement to professional levels in adolescent athletes undergoing UCLR. The combination of a lack of adherence to consensus guidelines and misconception

Disclaimer

The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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    New York University Langone Medical Center Office of Science and Research Institutional Review Board deemed approval not applicable as the study did not contain human subjects research.

    Investigation conducted at New York University Hospital for Joint Diseases, New York, NY, USA.

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