All right, so I appreciate my co-authors, an opportunity at ANA to speak today. So background on this study, and we can probably talk about this when we get done with all the questions. I think there's too many UCL repairs going on now. I think industry is pushing people to do a surgery that's unnecessary. So the point of this study was to look at the ability to do non-operative care and get throwing athletes back to throwing without surgery. And so what we were doing is basically look at throwing athletes, classifying their injury based off a classification system we developed, and to see what their responses were to biologic. So we basically used PRP to treat a UCL injury in all throwing athletes. We stratified them by type 1, 2, 3, and 4 tears, with type 1 and 2s being partial tears. And we identified it with about a nine-week rehab protocol. And we identified which returned to play, which needed surgery, and which did not return to play. So we had 50 patients, retrospective review, MRI diagnosed by UCL. We had four types in our classification system, subdivided into area of injury on the humerus or ulna. So this is a normal MRI. Here's your black band of your UCL. Here's a type 1. What you see is edema right here in the UCL. So this is what we call a low-grade partial tear. You don't see a full tear, but you definitely see edema within the UCL. A type 2 tear, you still see the ligaments intact. There's no extravasation of fluid into the soft tissues, but it's clearly torn. So this is a type 2, a high-grade partial tear. Here's a type 3 with extravasation of the fluid in the tendon. That goes to the point I'd recommend you get arthrograms on all your patients who are concerned about a UCL. Timmerman first described this T sign as the pathognomonic sign for UCL injury on CT arthrograms. And a type 4 is a very complex tear. Injuries in more than one location, humerus and ulna. So we took a 60 milliliters of whole blood, 50 milliliters centrifuge. You all know how PRP works. We did not separate or we did not differentiate between leukocyte-poor or leukocyte-rich PRP. We used ultrasound guidance injected right into the site of injury. No insets for six weeks. Massive range of motion for three weeks. Usually if no pain, full throwing by nine weeks. So we stratified into four groups. Group A, full recovery, return to throwing, return to pre-injury level. No additional rehab. Group B, maybe needed a little additional rehab, setback, maybe a second shot. Group C, got back to sports but needed surgery. Group D, failed to return to sports. So if you look at our cohort, roughly we had 23 low-grade partial tears, 16 high-grade partial tears. That's 39 partial tears in total. And that goes right along with our UCL reconstructions and fellowship. And the majority of them by far were partial tears. We only had three complete tears and we had eight complex tears. And if you stratify how well they did, we had 15 get back without any additional work and another 11 get back, maybe needing a second shot or needing a little additional rehab. But 22 ended up not returning to play. So looking at type 1, type 2, and type 3s only, removing the complex tears, which are very bad and you'll see that on the next slide, 60% of our patients were able to get back to play without any form of surgical management. Just maybe a little additional rehab, maybe a biologic injection. The type 4 tears, only 12.5% got returned to play with non-operative management. So what we found is that, again, just like our MRI studies showed, a majority of UCL injuries are often humerus. The majority of them are partial tears, owner origin less likely. But we also found more than one PRP injection did not add additional benefit. Additionally, we do feel that our classification system is a prognostic indicator. We do feel that type 1 or type 2 tears do demonstrate a possibility of having a good outcome with non-operative management, whereas your type 3 and your type 4s, you may want to start steering them towards surgical management. Our limitations are a lack of control group. There is variability in physical therapy regimens as well as PRP. We all know that. There's no uniform patient cohorts in a small sample size, but we do feel type 1 and type 2s provide great promise to reduce the need of surgical interventions. Type 3, we only had three, and all three got back to play without surgery. However, those numbers are low, so I'm a little skeptical of them. Type 4, minimal response. If you see a complex tear, you probably should be having a surgical discussion right away with the patient. So I do think biological injections are a good augment with rehab to non-operative care of partial UCL tears, and I think it offers the patient an improved recovery, quicker return to play, and hopefully an unnecessary surgical procedure. Thank you.

UCL injuries

non-operative care

throwing athletes

PRP injections

partial UCL tears