Elbow Ulnar Collateral Ligament Reconstruction in Javelin Throwers at a Minimum 2-Year Follow-up

Abstract

Background: There are several large series of outcomes after ulnar collateral ligament (UCL) reconstruction that have 1 or 2 javelin throwers included. To our knowledge, however, there are no reports that focus solely on the results of UCL reconstruction in this group of athletes. Hypothesis/Purpose: We hypothesize that by using modern UCL reconstruction techniques, javelin throwers can reliably expect to return to their sport. Additionally, we review the principles behind postoperative rehabilitation in these athletes, as it differs from the usual approach used with baseball players. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective review of 10 javelin throwers who underwent UCL reconstruction between 2006 and 2009 using the docking technique. There were 5 college and 5 high school javelin throwers. The average age was 18.5 years (range, 18-21 years). All patients, before being indicated for ligament reconstruction, failed a course of nonoperative management that included rest, physical therapy, and a structured attempt to return to throwing. Postoperatively, patients were evaluated using the Conway Scale and the Andrews-Timmerman Score. Results: Patients were evaluated at a minimum 2-year follow-up. The average follow-up was 28.9 months after surgery (range, 24-45 months). On the Conway Scale, 9 of the 10 players had excellent outcomes (90%). There was one fair (10%) outcome. Average time to return to previous level of competition was 15 months. The mean Andrews-Timmerman Score was 97 (range, 85-100). Overall, 100% (10/10) of the patients were subjectively satisfied with their clinical outcome. Conclusion: Similar to other overhand athletes with UCL insufficiency, javelin throwers can reliably expect to return to their previous level of play after surgical reconstruction. A thorough understanding of the unique demands placed on these athletes because of the different throwing motion is helpful when tailoring their postoperative rehabilitation protocol. Additionally, these athletes must be counseled that the postoperative course is associated with an extended period of time until return to previous level of competition when compared with baseball players.