Erickson Brandon J, Hurley Eoghan T, Mojica Edward S, Jazrawi Laith M
Rothman Institute, New York, New York, U.S.A..
NYU Langone Health, New York, U.S.A.; Sports Surgery Clinic, Dublin, Ireland; Duke University Medical Center, Durham, North Carolina, U.S.A.
Arthroscopy. 2023 May;39(5):1161-1171. doi: 10.1016/j.arthro.2022.12.033. Epub 2023 Feb 14.
To establish consensus statements on the treatment of ulnar collateral ligament (UCL) injuries and to investigate whether consensus on these distinct topics could be reached.
A modified consensus technique was conducted among 26 elbow surgeons and 3 physical therapists/athletic trainers. Strong consensus was defined as 90% to 99% agreement.
Of the 19 total questions and consensus statements 4 achieved unanimous consensus, 13 achieved strong consensus, and 2 did not achieve consensus.
There was unanimous agreement that the risk factors include overuse, high velocity, poor mechanics, and previous injury. There was unanimous agreement that advanced imaging in the form of either magnetic resonance imaging or magnetic resonance arthroscopy should be performed in a patient presenting with suspected/known UCL tear that plans to continue to play an overhead sport, or if the imaging study could change the management of the patient. There was unanimous agreement regarding lack of evidence for the use of orthobiologics in the treatment of UCL tears as well as the areas pitchers should focus on when attempting a course of nonoperative management. The statements that reached unanimous agreement for operative management were regarding operative indications and contraindications for UCL tears, prognostic factors that should be taken into consideration in when performing UCL surgery, how to deal with the flexor-pronator mass during UCL surgery, and use of an internal brace with UCL repairs. Statements that reached unanimous agreement for return to sport (RTS) were regarding portions of the physical examination should be considered when determining whether to allow a player to RTS; unclear how velocity, accuracy, and spin rate should be factored into the decision of when players can RTS and sports psychology testing should be used to determine whether a player is ready to RTS.
V, expert opinion.
制定关于尺侧副韧带（UCL）损伤治疗的共识声明，并调查在这些不同主题上是否能达成共识。
在26名肘部外科医生和3名物理治疗师/运动训练师中采用改良的共识技术。强烈共识定义为90%至99%的一致同意。
在总共19个问题和共识声明中，4个达成了一致共识，13个达成了强烈共识，2个未达成共识。
对于危险因素包括过度使用、高速、力学不佳和既往损伤，达成了一致共识。对于计划继续从事过头运动的疑似/已知UCL撕裂患者，或者如果影像学检查可能改变患者的治疗方案，应以磁共振成像或磁共振关节镜形式进行高级影像学检查，达成了一致共识。对于在UCL撕裂治疗中使用骨科生物制剂缺乏证据以及投手在尝试非手术治疗过程中应关注的领域，达成了一致共识。对于手术治疗达成一致共识的声明包括UCL撕裂的手术适应症和禁忌症、进行UCL手术时应考虑的预后因素、UCL手术期间如何处理屈肌-旋前肌团以及UCL修复时使用内固定支架。对于恢复运动（RTS）达成一致共识的声明包括在确定是否允许运动员RTS时应考虑的体格检查部分；不清楚在决定运动员何时可以RTS时应如何将速度、准确性和旋转速率纳入考量，以及是否应使用运动心理学测试来确定运动员是否准备好RTS。
V，专家意见。
