Study Shows Sharp Rise in UCL Injuries and Surgeries Among Youth Throwing Athletes

Prevention and monitoring can reduce “Tommy John” injuries

Throwing athletes under the age of 18 have specialized biomechanic considerations and risk profiles that are leading to higher rates of ulnar collateral ligament elbow injuries, commonly known as a Tommy John injury, says a new clinical review conducted at Hoag Orthopedic Institute (HOI) and published in the latest Journal of Bone and Joint Surgery Reviews.

The analysis explores the concerning spike in UCL injuries among pediatric and adolescent throwing athletes. Baseball pitchers are particularly susceptible.

"Adolescent athletes are undergoing UCL reconstruction at increasing rates," said Hafiz F. Kassam, M.D., director of shoulder reconstruction at HOI and one of the report’s authors. "The high velocity, intensity and sheer volume of pitching in year-round play among younger players places unique stress on an immature elbow, therefore increasing the risk of injury. The increase is particularly alarming given that these injuries were historically seen in older, professional players."

The investigation highlights a dramatic increase in UCL reconstructions in athletes under 18. Once rare, surgeries in this age group now account for nearly a third of all UCL procedures (Tommy John surgeries) at some major orthopedic centers.

The paper addresses the efficacy of the various conservative and surgical approaches to UCL injuries. Physical therapy, kinetic chain strengthening and regenerative therapies such as Platelet-Rich Plasma (PRP) have been identified as potential conservative options. UCL reconstruction, primary repair and repair with augmentation are examined and dictated by patient and injury characteristics.

“It’s not just about pitch counts. The mechanics, expectations and pressures on adolescent throwers are different, and the solutions need to be as well,” said Dr. Kassam. “Further studies focused specifically on youth athletes, whose anatomical and developmental differences set them apart from adult counterparts, are needed.”

The research team included physicians and researchers Abhay Mathur, M.D.; Jordan Frausto, B.A.; Carlos Ramirez, B.S.; Adam Lindsay, M.D.; Viraj Deshpande, B.S.; Evan Simpson, B.S.; and Patrick Saunders, M.D., who reviewed national and state-level surgical data, biomechanics studies and long-term athlete follow-ups.

The study abstract can be found here: Ulnar Collateral Ligament Injuries in Pediatric and Adolescent Throwing Athletes