This review aimed to assess an overhead throwing athlete’s ability to return to competition after ulnar collateral ligament reconstruction. It was concluded that the figure-of-eight and docking techniques in particular provide excellent results. These conclusions are supported by the evidence presented but need to be confirmed by further higher quality studies.

To assess an athlete’s ability to return to competition after ulnar collateral ligament reconstruction.

MEDLINE, EMBASE and the Cochrane Library were searched from inception to 31 August 2005; the search terms were reported. The reference lists of included studies were also checked for potentially relevant reports. Unpublished material and conference abstracts were excluded.

All types of studies with a cohort of patients that had a minimum of 1 year’ follow-up were eligible for inclusion.  The duration of follow-up ranged from 3 to 6 years.

Studies that assessed ulnar collateral ligament reconstruction were eligible for inclusion. Post-operative rehabilitation was similar in all studies: athletes began range of motion exercises after 7 to 10 days, a throwing programme was initiated at 4 months, pitching was initiated after 6 to 7 months, and patients were allowed to return to competition after 9 to 12 months.

Eligibility criteria for the patients were not clearly specified. It appears that studies of overhead throwing athletes were eligible for inclusion. The mean age in the included studies ranged from 21 to 24 years. There was, at most, one female patient per study. Most of the patients were baseball players at the professional or collegiate level.  Fourteen to 16% of the patients had previously undergone elbow surgery.

Studies that reported on ability to return to competition were eligible for inclusion.  The outcomes of interest were ability to return to play level (i.e. to overhead throwing activities) and complications. The outcome categories for return to play level were ‘excellent’ (return to same or higher level of play), ‘good’ (return to competition at lower level), ‘fair’ (return to recreational play) and ‘poor’ (inability to return to play).

The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.

The studies were assessed for selection, performance, attrition and detection biases. 

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction. Data were extracted on the type of study, number of patients, number of patients with previous surgery, number of patients at final follow-up, percentage of patients at final follow-up, average length of follow-up, graft used, surgical technique, number of surgeons, additional procedures performed at surgery, complications, rehabilitation protocol and outcomes (ability to return to competition).

The studies were combined in a narrative, with accompanying tables.

Differences between the studies were discussed in the text.

Four retrospective cohort studies (281 patients, 253 ligament reconstructions) were included.

Excellent results were reported in 68 to 92% of the cases (55 to 92% with previous surgery and 74 to 93% without) using figure-of-eight and docking techniques; good results were reported in 0 to 13% of cases. The most commonly reported complication was transient ulnar neuropathy.

All studies had a follow-up rate of at least 70%.  The authors reported evidence of selection bias and performance bias, as well as minimal attrition bias.

Ulnar collateral ligament reconstruction can return the athlete to previous or higher levels of play. In particular, the figure-of-eight and docking techniques provide excellent results.

The research question was defined in terms of the intervention, outcome and study design, but was less clear in relation to the participants. Several relevant sources were searched, although the exclusion of unpublished material means there is the potential for publication bias, which might have affected the results. The validity of the studies was assessed and taken into account, although this was based on a general discussion of potential biases rather than a formal quality assessment. It was stated that all the included studies were retrospective cohort studies, but no indication of the control groups was given in the review article; it therefore appears more appropriate to categorise the studies as case series. In addition, more detailed information about complications would have been desirable. Overall, the evidence presented supports the authors’ conclusions, but needs to be confirmed by further studies of higher quality.

The authors did not state any implications for practice or further research.

Not stated.

This record is a structured abstract written by CRD reviewers. The original has met a set of quality criteria. Since September 1996 abstracts have been sent to authors for comment. Additional factual information is incorporated into the record. Noted as  [A:....].