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Epidemiology of Elbow Ulnar Collateral Ligament Injuries in National Collegiate Athletic Association Sports: 2009-2010 to 2013-2014 Academic Years
Steven F DeFroda, MD; Avi D Goodman, MD; Joseph A Gil, MD; Brett Owens, MD
Brown University, Providence, RI

Introduction Injury to the elbow ulnar collateral ligament (UCL) in baseball pitchers can be a devastating injury, often leading to time away from sport, and potentially surgical intervention. Injury rates have been variously reported as 1.09 per 1000 athlete exposures in minor league pitchers and 5.8 per 1,000 athlete exposures in college baseball players from 1988-2004. Additionally, 25% of Major League Baseball (MLB) players and 15% of professional minor league baseball players have reported as needing UCL reconstruction following injury. Despite the recent increase in UCL tears in MLB players there is a paucity of literature on the recent epidemiological trends in these injuries in NCAA athletes.

Methods After NCAA and Institutional Review Board Approval, all UCL injuries sustained in menŐs baseball from 2009-10 to the 2013-2014 seasons in the NCAA Injury Surveillance System (NCAA ISS) database were retrospectively reviewed. Injuries were weighted to be nationally representative, characterized using descriptive statistics, and compared between groups. These comparisons included throwing versus non-throwing, early in play (warm-up through 3rd inning) versus late in play (4th inning onwards), and competition versus practice. The incidence was calculated in terms of injuries per 10,000 athletic exposures (AE), assuming a Poisson distribution.

Results The incidence of UCL injuries in NCAA baseball players from 2009-2014 was 1.36 per 10,000 athlete exposures (AE) (Figure 1). Of all players injured, a large number 19.8% missed 1-2 weeks of competition while 15.3% missed the rest of the season following injury (Figure 2), and 13.3% required surgery. Injuries were also more common later in games, with 1.16/10,000 AE after the 4th inning compared with 0.32/10,000 AE early in the game, for a relative risk of late game UCL injury of 3.59 (CI 3.37 - 3.9). Injuries were also more common during competition; 1.68/10,000AE, compared to 0.97/10,000 AE during practice, with a risk ratio of 1.73 (CI 1.73-1.73) (Figure 3).

Conclusion We found a decrease in the incidence of UCL injuries in NCAA athletes compared to previously published data from 1988-2004. In our study, only 15% of players were sidelined for the season after injury, and only 13% required surgery, potentially demonstrating that trainers have a low threshold to diagnose UCL injury and rest players appropriately. We also found that more injuries occur later in games, confirming an association between injury and pitch count in these athletes. More research is needed specifically in identifying NCAA athletes at risk for UCL injury.

Figure 1.

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Figure 2

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Figure 3

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