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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >MRI Predictors of Failure in Non-operative Management of Ulnar Collateral Ligament Injuries in Professional Baseball Pitchers
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MRI Predictors of Failure in Non-operative Management of Ulnar Collateral Ligament Injuries in Professional Baseball Pitchers

机译：专业棒球投手的尺寸侧韧带损伤的非手术管理失败的MRI预测因素

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Objectives: Ulnar collateral injuries (UCL) of the elbow are prevalent among professional baseball pitchers. The decision on initial operative versus nonoperative management of these injuries remains subjective in many cases, with reported success rates with nonoperative management ranging from 42 to 93% in professional throwing athletes. No studies to date have identified objective characteristics specific to success or failure of nonoperative intervention. The purpose of this study was to identify radiologic predictors for success or failure in nonoperative management of ulnar collateral ligament injuries in professional pitchers. Methods: A retrospective review of pitchers sustaining UCL injuries between 2006 and 2015 from one professional baseball organization (one major league team and all minor league teams included) was performed. UCL injuries were identified in 38 players based on clinical and radiographic findings. Six players underwent initial surgical intervention without attempted nonoperative intervention and were excluded from analysis. This left 32 (84%) professional pitchers who underwent an initial trail of nonoperative treatment for partial UCL tears. Success was defined as return to same level of play (RTSP) or higher for >1 year. Failure was defined as recurrent pain or weakness requiring surgical intervention after a minimum of 3 months’ rest when attempting a return to throw rehabilitation program. MRI findings were classified as high or low grade sprains, proximal or distal location of injury, and with or without the presence of concomitant chronic findings. Results: Of the 32 patients who underwent nonoperative management, 10 (36%) failed and required subsequent ligament reconstruction. Between the success and failure groups, there was no significant difference seen in total shoulder arc of motion (P=.7776), shoulder internal rotation deficit (P=.3846) or loss in elbow extension (P=.0644) at the time of injury. When comparing MRI findings between the groups, distal tears were found in 90% (9/10) of those who failed nonoperative management compared to 18.2% (4/22) who were successful nonoperatively (P=<.0001). No significant difference was seen with high grade tears (P=.0817) between the groups. When adjusting for age, location and evidence of chronic changes on MRI, the likelihood of failing nonoperative management was 22.7 times greater (P=.001) with distal tears. No other variable reached significance, and no combination of variables showed a greater likelihood than distal location alone. Conclusion: In professional pitchers, distal ulnar collateral ligament tears described on MRI show significantly higher rates of failure with nonoperative management compared to proximal tears. This information provides an objective measure for evaluating operative versus nonoperative management of ulnar collateral ligament injuries in throwing athletes.
机译：目标：肘部的乌尔没有抵押品伤害（UCL）在专业棒球投手中普遍存在。关于初步操作与非手术管理这些伤害的决定仍然是许多情况的主观，报告的成功率与非专业投掷运动员的42％至93％。迄今为止没有研究已经确定了对非手术干预成败的客观特征。本研究的目的是识别放射学预测因子，以便在专业投手中的乌尔侧韧带伤害的非手术管理中的成功或失败。方法：对投手的回顾性审查2006年至2015年从一个职业棒球组织（一名主要联盟队和包括所有未成年联盟团队）的UCL伤害。基于临床和放射线摄影结果，在38名球员中确定了UCL伤害。六名球员接受了初始手术干预而不尝试非手术干预，并被排除在分析之外。这留下了32（84％）专业投手，他们接受了初始ucl撕裂的非手术治疗的初始迹。成功被定义为返回同一级别（RTSP）或更高级别> 1年。失败被定义为在尝试恢复恢复计划时至少3个月的休息后，需要手术干预的复发疼痛或弱点。 MRI调查结果被归类为高或低级别的扭伤，近端或远端损伤位置，有或没有伴随的慢性发现。结果：32例接受非手术管理的患者，10（36％）失败，后续韧带重建。在成功和失败群体之间，总肩弧中没有显着差异（P = .7776），肩部内部旋转缺陷（P = .3846）或肘部延伸的损失（P = .0644）时伤害。当比较群体之间的MRI调查结果时，与非手术成功的18.2％（4/22）相比，在40％（9/10）中发现了远端眼泪（9/10）。在组之间的高档撕裂（p = .0817）没有显着差异。在调整年龄，慢性变化的年龄，慢性变化的证据时，未经证实的管理失败的可能性是远端撕裂的22.7倍（p = .001）。没有其他变量达到意义，并且没有变量的组合表现出比单独的远端位置更大的可能性。结论：在专业投手中，与近端眼泪相比，MRI描述的远端尺寸侧韧带撕裂显示出明显更高的失效率。该信息提供了对抛投球人的乌尔侧韧带损伤的可操作与非目标管理的客观措施。

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