The influence of chronic medial epicondylar apophysitis on medial ulnar collateral ligament insufficiency-: a retrospective cohort study

Kenichi Otoshi; Shinichi Kikuchi; Kinshi Kato; Yota Kaneko; Ryosuke Mashiko; Ryohei Sato; Takahiro Igari; Takahiro Kaga; Shinichi Konno

doi:10.1016/j.jseint.2021.12.014

The influence of chronic medial epicondylar apophysitis on medial ulnar collateral ligament insufficiency-: a retrospective cohort study

JSES Int. 2022 Feb 1;6(3):539-544. doi: 10.1016/j.jseint.2021.12.014. eCollection 2022 May.

Authors

Kenichi Otoshi^{1

2}, Shinichi Kikuchi³, Kinshi Kato³, Yota Kaneko³, Ryosuke Mashiko³, Ryohei Sato³, Takahiro Igari³, Takahiro Kaga¹, Shinichi Konno³

Affiliations

¹ Department of Sports Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan.
² Otoshi Orthopaedic Clinic, Oshu City, Iwate, Japan.
³ Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan.

Abstract

Background: This study aimed to investigate the effect of chronic traction apophysitis of the medial epicondyle (MEC) on medial ulnar collateral ligament (MUCL) insufficiency in high school baseball players.

Methods: In this retrospective cohort study, 3034 of 6069 high school baseball players were enrolled. A self-reported questionnaire was distributed to investigate past history of elbow pain and elbow pain during the previous season. Physical examinations to assess tenderness on the MUCL and the elbow valgus stress test (EVST) were performed. Ultrasonography was performed to determine the presence of morphological abnormalities of the anteroinferior aspect of the MEC (MEC lesions).

Results: Participants with MEC lesions had a significantly higher prevalence of past history of elbow pain, elbow pain during the previous season, MUCL tenderness, and positive EVST than those without MEC lesions (P < .05). Multivariate logistic regression analysis revealed that the participants with the fragmented type had the highest risk of past history of elbow pain (odds ratio [OR] = 3.94), elbow pain during the previous season (OR = 2.27), positive EVST (OR = 3.49), and the second highest risk of MUCL tenderness (OR = 2.01) followed by the irregular type (OR = 2.31). Participants with the hypertrophic type had the lowest risk of past history of elbow pain (OR = 2.08), elbow pain during the previous season (OR = 1.42), MUCL tenderness (OR = 1.09), and positive EVST (OR = 1.47).

Conclusion: The presence of chronic non-healed traction apophysitis of the MEC in high school baseball players presented a significantly high risk of elbow pain and MUCL insufficiency.

Keywords: Chronic nonhealed traction apophysitis; High school baseball player; Medial epicondyle; Medial ulnar collateral ligament Insufficiency; Retrospective cohort study.