Wednesday, April 25, 2012

Elbow Ligament Injuries, Tommy John Surgery and Platelet Rich Plasma

Baseball players especially pitchers create tremendous forces across the inside part of their elbows when throwing.  The inside part of the elbow is supported by a stout ligament---the ulnar collateral ligament.  Repetitive trauma in the form of pitching or an acute severe injury such as an elbow dislocation can result in a complete tear of this important stabilizing ligament.  Pitchers who sustain a complete tear are typically treated with "Tommy John" surgery---reconstruction of the ulnar collateral ligament.  

In athletes with partial injuries to this ligament, however, platelet rich plasma is emerging as an alternative treatment to surgery.  In a study presented at the American Academy of Orthopedic Surgery (2012) by Dr. Scott Crow et al, the value of PRP as a treatment for this injury was discussed.  94% of athletes returned to play within 10 weeks when treated with PRP.    

"...researchers followed 17 athletes with a partial UCL tear. All patients had failed conservative treatment, including rest and physical therapy. Baseline questionnaires, including the Kerlan-Jobe Shoulder and Elbow Score (KJOC Score) and Disability of the Arm, Shoulder, and Hand Score (DASH Score) were completed for each patient prior to the PRP injection. Each patient underwent a single PRP injection at the ulnar collateral ligament under ultrasound guidance.
At an average follow-up of 18 weeks (range 12-46 weeks), 16 of 17 athletes had returned to play. The average time to return to play was 10 weeks (range 8-12 weeks). The average KJOC Score improved from 47 to 93, p=.0001. The average DASH Score improved from 24 to 3, p=.003. The Sports Module of the DASH questionnaire improved from 74 to 6, p=.0001.
"There is little information in the literature regarding non-surgical treatment of UCL tears. Our results show that PRP may be an option to return players to the field without having to place them under the knife," said Crow."  See Full Press Release

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