Background:

Ulnar collateral ligament (UCL) reconstruction (UCLR) is a viable treatment option for patients with UCL insufficiency, especially in the overhead throwing athlete. Within the clinical literature, there is still no universally agreed upon optimal rehabilitation protocol and timing for return to sport (RTS) after UCLR.

Hypothesis:

There will be significant heterogeneity with respect to RTS criteria after UCLR. Most surgeons will utilize time-based criteria rather than functional or performance-based criteria for RTS after UCLR.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

All level 1 to 4 studies that evaluated UCLR with a minimum 1-year follow-up were eligible for inclusion. Studies lacking explicit RTS criteria, studies that treated UCL injury nonoperatively or by UCL repair, or studies reporting revision UCLR were excluded. Each study was analyzed for methodologic quality, RTS, timeline of RTS, and RTS rate.

Results:

Overall, 1346 studies were identified, 33 of which met the inclusion criteria. These included 3480 athletes across 21 different sports. All studies reported RTS rates either as overall rates or via the Conway-Jobe scale. Timelines for RTS ranged from 6.5 to 16 months. Early bracing with progressive range of motion (ROM) (93.9%), strengthening (84.8%), and participation in an interval throwing program (81.8%) were the most common parameters emphasized in these rehabilitation protocols. While all studies included at least 1 of 3 metrics for the RTS value assessment, most commonly postoperative rehabilitation (96.97%) and set timing after surgery (96.97%), no article completely defined RTS criteria after UCLR.

Conclusion:

Overall, 93.9% of studies report utilizing bracing with progressive ROM, 84.8% reported strengthening, and 81.8% reported participation in an interval throwing program as rehabilitation parameters after UCLR. In addition, 96.97% reported timing after surgery as a criterion for RTS; however, there is a wide variability within the literature on the recommended time from surgery to return to activity. Future research should focus on developing a comprehensive checklist of functional and performance-based criteria for safe RTS after UCLR.

中文翻译：

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尺侧副韧带重建后的康复和恢复运动标准：系统评价

背景：

尺侧副韧带 (UCL) 重建 (UCLR) 是 UCL 功能不全患者的可行治疗选择，尤其是在过头投掷运动员中。在临床文献中，UCLR 后的最佳康复方案和恢复运动 (RTS) 的时间仍然没有得到普遍认可。

假设：

UCLR 之后的 RTS 标准将存在显着的异质性。大多数外科医生将在 UCLR 后使用基于时间的标准，而不是基于功能或性能的 RTS 标准。

学习规划：

系统审查；证据水平，4。

方法：

所有评估 UCLR 且至少随访 1 年的 1 至 4 级研究均符合纳入条件。缺乏明确的 RTS 标准的研究、非手术治疗或通过 UCL 修复治疗 UCL 损伤的研究或报告修订 UCLR 的研究被排除在外。对每项研究的方法学质量、RTS、RTS 时间线和 RTS 率进行分析。

结果：

总体而言，确定了 1346 项研究，其中 33 项符合纳入标准。其中包括来自 21 个不同运动项目的 3480 名运动员。所有研究都将 RTS 率作为总体率或通过 Conway-Jobe 量表报告。RTS 的时间表从 6.5 个月到 16 个月不等。渐进式运动范围 (ROM) (93.9%)、加强 (84.8%) 和参与间歇投掷计划 (81.8%) 的早期支撑是这些康复方案中最常见的参数。虽然所有研究都包括至少 3 个 RTS 值评估指标中的 1 个，最常见的是术后康复 (96.97%) 和术后设定时间 (96.97%)，但没有文章完全定义 UCLR 后的 RTS 标准。

结论：

总体而言，93.9% 的研究报告使用渐进式 ROM 支具，84.8% 报告加强，81.8% 报告参与间歇投掷计划作为 UCLR 后的康复参数。此外，96.97% 的人将术后时间作为 RTS 的标准；然而，文献中关于从手术到恢复活动的建议时间存在很大差异。未来的研究应侧重于为 UCLR 后的安全 RTS 制定功能和基于性能标准的综合清单。