Psychological Factors Associated With Return to Play After Ulnar Collateral Ligament Reconstruction: A Systematic Review

Aaron Z Chen; Kaylre M Greaves; Thomas A Fortney; Bryan M Saltzman; David P Trofa; Christopher S Ahmad

doi:10.1177/23259671221125746

Psychological Factors Associated With Return to Play After Ulnar Collateral Ligament Reconstruction: A Systematic Review

Orthop J Sports Med. 2022 Oct 7;10(10):23259671221125746. doi: 10.1177/23259671221125746. eCollection 2022 Oct.

Authors

Aaron Z Chen¹, Kaylre M Greaves¹, Thomas A Fortney¹, Bryan M Saltzman^{2

3}, David P Trofa¹, Christopher S Ahmad¹

Affiliations

¹ Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.
² OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA.
³ Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA.

Abstract

Background: The role of psychological factors in return to play (RTP) after ulnar collateral ligament (UCL) reconstruction remains unclear.

Purpose: To perform a systematic review of the literature to (1) identify the specific psychological factors that affect RTP after UCL reconstruction and (2) determine the proportion of failures to RTP after UCL reconstruction because of psychological factors.

Study design: Systematic review; Level of evidence, 4.

Methods: A systematic review of the literature following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted. We queried the Cochrane Database of Systematic Reviews, Ovid/Embase, PubMed, and Web of Science databases to identify studies examining psychological factors and RTP after UCL reconstruction. Data pertaining to study characteristics and design, clinical and demographic characteristics, and psychological factors were collected. Patients were pooled across included studies, weighted means were calculated, and descriptive statistical analysis was performed.

Results: A total of 8 studies consisting of 378 patients were included for analysis. The mean time to RTP was 12.2 months, and the overall RTP rate was 89.4%. Psychological factors affecting RTP included loss of interest, fear of reinjury, individual personality traits, personal reasons, and psychological concerns. While clinical factors accounted for 46.2% (n = 24) of failures to RTP, psychological factors comprised 40.4% (n = 21) of the reasons for failure to RTP. The most commonly cited psychological factors affecting RTP were loss of interest (n = 15 [28.8%]) and fear of reinjury (n = 3 [5.8%]).

Conclusion: Psychological factors represented a substantial proportion of failures to RTP after UCL reconstruction, especially in adolescent athletes. Future prospective studies and multicenter initiatives are needed to more thoroughly evaluate the psychological concerns of patients before and after UCL reconstruction.

Keywords: psychological factors; psychology; ulnar collateral ligament; ulnar collateral ligament reconstruction.

Publication types

Review