A Number of Modifiable and Nonmodifiable Factors Increase the Risk for Elbow Medial Ulnar Collateral Ligament Injury in Baseball Players: A Systematic Review.

Autor:	Labott JR; Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, U.S.A., Leland DP; Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, U.S.A., Till SE; Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, U.S.A., Diamond A; Minnesota Twins Baseball Club, One Twins Way, Minneapolis, Minnesota, U.S.A., Hintz C; Minnesota Twins Baseball Club, One Twins Way, Minneapolis, Minnesota, U.S.A., Dines JS; Hospital for Special Surgery, New York, New York, U.S.A., Camp CL; Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, U.S.A.. Electronic address: Camp.christopher@mayo.edu.
Jazyk:	angličtina
Zdroj:	Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2023 Aug; Vol. 39 (8), pp. 1938-1949.e1. Date of Electronic Publication: 2023 Jan 14.
DOI:	10.1016/j.arthro.2022.12.036
Abstrakt:	Purpose: To analyze the current literature regarding risk factors associated with medial ulnar collateral ligament (MUCL) injury in baseball players and to serve as a robust source for identifying modifiable risk factors that once optimized, have the potential to reduce injury risk. Methods: Comprehensive search of the available literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were included if they evaluated risk factors for MUCL injuries in the elbow of baseball players. Risk of bias assessment was performed via Methodological Index for Non-randomized Studies (MINORS) scoring system. The Oxford Centre for Evidence-Based Medicine was used to determine level of evidence. Variables of interest; player age, position, shoulder motion, humeral retrotorsion, joint laxity, strength, balance, geography, velocity, pitch count, pitch types, throwing volumes, and throwing mechanics were recorded. Results: Twenty-one studies were included in this systematic review. MINORS scores ranged from 75 to 87%, and variables demonstrated significant heterogeneity. Performance-based risk factors for MUCL injury included: increased pitch count (both annual and per game), higher percentage of fastballs thrown, smaller pitch repertoire, and/or a loss of pitching velocity. Biomechanical studies demonstrated the relationship between decreased shoulder range of motion (total ROM, ER, IR, and abduction), increased humeral retrotorsion, increased elbow valgus opening in the throwing arm, lower Y-Balance score, and increased lateral release position to increased MUCL injury. Conclusions: Risk factors for MUCL injury can generally be categorized into 4 primary groups: 1) various player demographics and characteristics, 2) throwing too hard (high velocity), 3) throwing too much (pitch count/volume), and 4) throwing with poor mechanics. In this systematic review, the most significant nonmodifiable risk factors for MUCL injuries included: increased glenohumeral retrotorsion and elbow valgus opening. The most consistent modifiable risk factors included: total shoulder range of motion, pitch count, pitch selection, Y balance score, and lateral release position. Pitch velocity was inconsistent in literature, but most studies found this as a risk for injury. These risk factors may serve as appropriate targets for future evidence-based injury mitigation strategies. Level of Evidence: Level IV, systematic review of Level II-IV studies. (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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