Hello, everybody. I'm Ryan Paul. I'm a first-year medical student at Hackensack Meridian and a prior research fellow at Rothman Orthopedics And I'll be presenting a study. I worked on with Dr. Cohen titled outcomes following arthroscopic posterior medial osteofibrosection and risk of future UCL reconstruction So valgus extension overload refers to the repetitive contact between the posterior medial olecranon and the posterior medial aspect of the olecranon fossa This repetitive contact leads to excess bone formation, which then leads to elbow pain and maximum extension, especially in the follow-through phase of pitching These athletes who fail conservative treatment of this are generally recommended for arthroscopic resection However Removing this posterior medial osteophyte can increase elbow joint translation and thus stress on the UCL during the throwing motion Because of this these athletes may be at an increased risk of subsequent UCL injury and ultimately a UCL reconstruction Therefore the purpose of this study was to report outcomes following arthroscopic resection of posterior medial osteophytes and overhead athletes and Determine if these athletes who underwent posterior medial osteophyte resection for posterior medial impingement went on to require UCL reconstruction This was a retrospective cohort study We included athletes ages 15 to 50 who underwent isolated arthroscopic posterior medial osteophyte resection at our institution over a 10-year period We use the following CPT codes and only included patients with a minimum one-year follow-up We excluded patients who had a concomitant UCL surgery or any prior elbow surgeries We performed retrospective chart review for preoperative physical therapy elbow range of motion overhead sport participation and level of competition and also for post-operative outcomes such as Complications elbow flexion and extension range of motion and patient reported outcomes such as return to sport subsequent injury and K jock score We screened 851 patients 72 underwent posterior medial osteophyte resection and 36 were included featuring 28 baseball pitchers 3 baseball catchers 3 softball players 1 tennis player and 1 volleyball player The demographics to the right show the demographics for all overhead athletes the subset of baseball pitchers only and non baseball pitchers Notably most baseball pitchers were at the collegiate level Mean follow-up was five years plus or minus three and a half and this ranged from one year to 11 years There were two patients who experienced a post-operative complication One was a high school softball infielder who had ulnar neuritis throughout a rehab process and later required a subsequent ulnar nerve transposition The other was a professional baseball pitcher who experienced ulnar neuritis for several weeks post-operatively, but was completely resolved within the first month Five baseball pitchers required a subsequent UCL reconstruction at a median of 13 months post-op this included Three short term at 6 7 and 13 months post-op and too much longer term at 6.2 and 7.5 years post-op 75% of baseball pitchers were able to return to sport and 68% were able to return to the same level of sport at a mean of six months post-op Here are the functional outcomes for overhead athletes and baseball pitchers only baseball pitchers had a mean KJAC score of 66 most athletes were either Improved or completely resolved symptoms and only 50% 58% of athletes reported full elbow range of motion at longest term follow-up a Main driver for this study was data from prior cadaver studies Which found that if greater than three millimeters of posterior medial osteophyte was resected That the elbow gains significant elbow range of motion, but also significant stress on the UCL so this made us wonder whether the UCL is incompetent in the setting of posterior medial osteophyte resection and Whether it should be reconstructed or repaired at the time of surgery However, the data from our study supports that we do not need to do this that the UCL is competent and we do not need to perform This UCL reconstruction because 82% of our athletes did not experience a subsequent UCL injury Several limitations to this study include we did not evaluate pre and post-operative workload it was unclear how many of these complications and subsequent injuries were due to the osteophyte resection itself and The amount of osteophyte resection was not quantified In conclusion baseball pitchers who undergo arthroscopic resection of a posterior medial osteophyte Have an 18% risk of subsequent UCL reconstruction and it does not appear that a UCL reconstruction needs to be performed in athletes Undergoing a posterior medial osteophyte resection unless the UCL is symptomatic Thank you, thank you very much

UCL reconstruction

valgus extension overload

arthroscopic resection

athletes

elbow pain