92% of patients return to play after UCL repair with internal brace — Dr. Jeffrey Dugas explains his research

Eric Oliver -  

In the twilight of 2016, then-St. Louis Cardinals pitcher Seth Maness underwent a procedure to repair his partially torn ulnar collateral ligament. He returned to the big leagues just seven and a half months after the procedure and is now pitching in the Texas Rangers' organization.

Maness underwent UCL repair with internal brace, which until recently was a burgeoning alternative to full UCL reconstruction for pitchers with partially torn labrums. The procedure cuts recovery time from 12 to 18 months for full reconstruction to only six to eight months with repair.

In early April, Birmingham, Ala.-based Andrews Sports Medicine & Orthopaedic Center's Jeffrey Dugas, MD, and colleagues published a study in The American Journal of Sports Medicine that found that 92 percent of the 111 athletes who received UCL repair with internal brace returned to the same or a higher level of competition in 6.7 months on average; an unprecedented success.

If Mr. Maness made the first throws toward innovation, the recently published study is the final pitch of a perfect game snapping against the leather of a catcher's mitt as the umpire signals for the final out.

Dr. Dugas elaborated on the results to Becker's, crediting the high return-to-play rate to the care he and other physicians paid to staying within the indications for repair. While the procedure is a viable option for select candidates, he expected the high rate because "it worked well for the people we knew it would work well for," he said.

Repair is successful in patients with enough healthy tissue to support the repair. Dr. Dugas urged orthopedic surgeons who would consider the procedure to ensure they are comfortable with reconstruction to begin with. Not only are Dr. Dugas and colleagues well-versed in reconstruction, they achieved a high level of success with repair because they didn't try to go beyond the indications.

"If you haven't seen the spectrum of pathology from little injury to significant injury, from good tissue to bad tissue, to tissue deficiencies and bone tissue replacement — if you haven't seen all those things, [I recommend you] stick with reconstruction because it's the universal operation for this problem regardless of the pathology."

Regarding how MLB and MLB teams will approach repair, Dr. Dugas expects it'll be slow at first but gain momentum as more players return from the procedure.

"I'd expect MLB and some of the teams would be slow to do this, but I do think it'll happen; there will be some more that'll do it and we'll see some players come back and it'll be more popular," he said.

Since the study's publication, Dr. Dugas said orthopedic surgeons have reached out from around the country to congratulate him, and while he is thankful for the praise, he said repair wouldn't be where it is today without their collective works and support. He specifically recognized the work of New Orleans-based Tulane University's Buddy Savoie III, MD.

Dr. Savoie published a study on UCL repair with suture anchors in the early 2000s. When Dr. Dugas began developing repair with internal brace, he reached out to Dr. Savoie for his insights into repair with suture anchors.

Curbing the epidemic
Although repair has the same transformative potential reconstruction has, both are Band-Aids to a greater issue: the Tommy John epidemic. Reconstruction rates continue to rise year after year, with the majority of reconstructions occurring in the 18-and-under demographic.

On what the orthopedic industry is doing to combat the epidemic, Dr. Dugas elaborated on the importance of mandated pitch counts, multisport specialization and taking multiple months off from pitching. To that point, the National Federation of State High School Associations recently recommended all states implement a pitch-count. While the federation doesn't make the rules, most states base their guidelines on the national recommendation.

"It's a huge step forward and I think it'll take only five years to realize the benefit of that," Dr. Dugas said. "As an orthopedic community, we're centered on injury prevention."

One other problematic trend Dr. Dugas and the orthopedic community have seen is high school-level athletes doing heavy weightlifting in-season. The strain of in-season weightlifting puts unnecessary stress on pitchers' elbows and was a trend MLB moved away from several decades ago. Dr. Dugas urged all surgeons to share the benefits of band work and light weights in season, instead of heavy lifting.

Just as Mr. Maness and 102 other pitchers prepare to take the mound, the emergence of UCL repair with internal brace, too, is ready to curb an epidemic.

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