Clinical Utility Of An MRI Based Classification For Operative Versus Non-operative Management Of UCL Tears: Two-year Follow Up

Abstract

Objectives: A recently introduced classification of medial ulnar collateral ligament (UCL) tears accounting for location and severity has demonstrated high interobserver and intraobserver reliability, but little is known about its clinical utility. The purpose of this study was to assess the relationship of the MRI-based classification system in predicting which athletes succeeded non-operative versus operative treatment after completing a standardized rehabilitative program. Secondary objectives included sub-analysis of baseball players, including return-to-play (RTP) and return-to-prior performance (RPP). Methods: After a priori power analysis, 58 consecutive patients with UCL tears and a minimum of two-year follow-up were retrospectively classified into those succeeding operative versus non-operative treatments. The MRI-based classification system accounting for UCL tear location and severity were correlated with non-operative and operative cohorts. Sub-analyses for baseball players, including RTP and RPP, were performed. Results: A total of 58 patients (40 baseball players, 34 pitchers) met inclusion criteria. A total of 35 patients (32 baseball players, 27 pitchers) underwent surgery, and 23 patients (8 baseball players, 7 pitchers) completed non-operative management. No patients in the non-operative arm crossed over to surgery after completing the rehabilitative program. Patients with distal (OR: 48.0, p=0.0004) and complete (OR: 5.4, p=0.004) tears were more likely to undergo surgery. Baseball players, regardless of position, were confounding determinants of operative management, although there was no difference in RTP and RPP between treatment arms. Conclusion: A six-stage MRI-based classification addressing UCL tear grade and location may confer early decision-making as patients likely to fail non-operative treatment have complete, distal tears whereas those with proximal, partial tears may be more amenable to non-operative modalities. Summary of eligible baseball players with UCL tears stratified by MRI-based classification Non-operative Operative Total 1A (Partial Proximal) 6 0 6 1B (Complete Proximal) 0 4 4 2A (Partial Midsubstance) 0 1 1 2B (Complete Midsubstance) 2 5 7 3A (Partial Distal) 0 9 9 3B (Complete Distal) 0 13 13