Return to Play After Platelet-Rich Plasma Injection for Elbow UCL Injury: Outcomes Based on Injury Severity

Background:

Ulnar collateral ligament (UCL) injuries of the elbow are uncommon in the general population but prevalent in the athletic community, particularly among baseball players. Platelet-rich plasma (PRP) injection therapy has become a popular nonoperative adjuvant treatment for such injuries to help reduce recovery time and avoid surgery.

Purpose/Hypothesis:

To analyze patient outcomes by injury severity and identify injury types that responded most favorably and unfavorably to PRP treatment. It was hypothesized that PRP therapy would prove to be most beneficial in the treatment of lower-grade, partial UCL tears and less effective in the treatment of more severe, complete UCL tears.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A cohort of 50 patients with UCL injuries in their dominant elbow, diagnosed by MRI (magnetic resonance imaging) arthrogram, underwent PRP therapy in conjunction with an established rehabilitation program. UCL injuries were classified by MRI as low-grade partial tear (Type I), high-grade partial tear (Type II), complete tear (Type III), or tear in more than 1 location (Type IV).

Results:

In total, 24 of 39 (61.5%) Type I and II tears, 3 of 3 (100%) Type III tears, and 1 of 8 (12.5%) patients with Type IV tears responded to UCL PRP injection therapy and were able to return to play without surgery. Ten patients required subsequent UCL PRP injections, of which 3 (30%) were able to return to sport without surgery.

Conclusion:

PRP treatment for Types I and II UCL tears shows great promise when combined with physical therapy and a rehabilitation program. Type III UCL tears demonstrated a high rate of success, although with low cohort numbers. Type IV UCL tears did not appear to respond well to PRP injection therapy and often required surgical intervention or cessation of sport. Therefore, PRP treatment does not appear to be appropriate for patients with complete Type IV UCL tears but may enhance recovery and improve outcomes in throwing athletes with Types I, II, and III UCL injuries.

ILIAC CREST HEIGHT DIFFERENCE AND OTHER RUNNING-RELATED VARIABLES' RELATIONSHIP WITH RUNNING INJURY

BACKGROUND

Leg-length inequality (LLI) is a common condition that may contribute to various spinal, pelvic, and lower extremity dysfunctions. Iliac crest height difference (ICHD) has been demonstrated to be a good estimate for LLI and may be a useful measure for identifying individuals who are at risk for injury.

PURPOSE

To investigate the relationship between ICHD and other running-related variables with running injury.

METHODS

An observational retrospective case-control design was used. Data were collected via questionnaire and physical examination from a purposive sample of 100 runners and were analyzed using chi-squared tests of independence.

RESULTS

The prevalence of ICHD ≥ 5mm reported by subjects via questionnaire was ∼40%. There was no difference in report of injury between subjects with ICHD >5mm and those with ICHD <5mm (χ² = 0.02, p = 0.88); however, lifetime history of injury (χ² = 15.68, p = 0.00) and the number of running events participated (χ² = 3.09, p = 0.04) were significant factors associated with injury; although not significant, there was a trend towards relationship with gender (χ² = 3.2, = 0.07).

CONCLUSION

Small ICHD is not associated with running injury among recreational runners. There appears to be an increased risk of running injury among runners who participate in more than one running event annually and those that have had a past history of running injury. Also, males may be at slightly greater risk of sustaining a running injury compared to females.

LEVEL OF EVIDENCE

Therapy, level 3b.

PAIN AND PHYSICAL PERFORMANCE AMONG RECREATIONAL RUNNERS WHO RECEIVE A CORRECTION FOR AN ILIAC CREST HEIGHT DIFFERENCE: A CASE SERIES

BACKGROUND

Leg-length inequality (LLI) is a musculoskeletal condition where one lower extremity is longer than the other. There is conflicting evidence on the relevance of LLI and conservative treatment options. Iliac crest height difference (ICHD) is a good estimate of LLI.

OBJECTIVE

To observe changes in pain and performance among recreational runners with running-induced lower extremity pain who received ICHD correction.

METHODS

A 12-week case series with multiple baseline and intervention (A-B-A-B) phases was used to observe the effects of ICHD correction on pain and performance among three symptomatic recreational runners. Primary outcome measures included the Lower Extremity Functional Scale (LEFS), the Visual Analog Scale -Worst Pain (VAS-W), symptom-free running distance, and average running speed. A standardized procedure for fabricating an in-shoe shim was utilized for ICHD correction.

RESULTS

There were no clinically important differences in functional capacity for any subject between any phases. Also, two subjects demonstrated trends towards increased pain over the 12-week experimental period, whereas one subject demonstrated a decrease. One subject demonstrated a statistically significant increase in running distance during intervention phases, but the others demonstrated reductions. All subjects demonstrated trends towards increased running speed, but none were statistically significant.

CONCLUSION

The correction of small ICHD < 9mm did not improve pain or performance among recreational runners. Individuals with small ICHD may be able to effectively compensate for lower extremity asymmetries; therefore, correction seems to be unnecessary and potentially harmful in short-term.

LEVEL OF EVIDENCE

Therapy, level 4.