Poster 206: What are the Indications for Medial Ulnar Collateral Ligament Surgery in Baseball Players? An MRI Case-based Study

Objectives: Ulnar Collateral Ligament (UCL) tears are common in baseball players. When non-operative management fails; reconstruction or repair may be necessary to restore physical function. There is no clear consensus regarding the indications for surgery based on magnetic resonance imaging (MRI) tear characteristics, selecting over reconstruction. The purpose of this study was define UCL MRI and elucidate vs Methods: Twenty-six orthopaedic surgeons who treat players were surveyed. Forty-five MRIs reviewed: 15 without tears, with intra-operatively confirmed partial-thickness full-thickness tears. Factors investigated included ligament characteristics (peri-ligamentous osseous edema, hypertrophy, calcification, partial tearing) location (proximal, mid-substance, distal). Surgeons given a clinical scenario asked whether 1) indicated 2) recommended. Odds ratios (OR) 95% confidence intervals (95%CI) helped identify significant predictors both queries. Results: odds recommending surgical treatment compared 2.4x more likely proximal tear, 3.2x distal 5.1x full- thickness 7.0x (p<0.001). Significant (OR=1.6, 95%CI 1.0, 2.1, p<0.001) (OR=1.7, 1.1, 2.3, p<0.001). Repair 3x less recommended mid-substance (OR=3.0, - 5.0, -1.0, p=0.004). Ultrasound stress testing requested 78% Conclusions: Among surveyed, highest operative then full-thickness, partial-thickness, partial- most appropriate but relatively contraindicated complete frequently Given lack among surgeons, future prospective registries determine these factors associate outcomes. [Table: see text]