Surgery and Rehabilitation Treatment Options for Ulnar Collateral Ligament Injuries of the Elbow for Baseball Athletes: A Systematic Review

Context: There is currently a lack of information on ulnar collateral ligament (UCL) injuries for athletic trainers. Most of the literature addressed the surgical options in detail and depending on the study, information for rehabilitation may be limited or not even included. Further, there are a limited number of studies that compare the different surgical techniques to each other as well.;Objective: To provide a comparison of the Jobe technique to the Docking technique, in regard to surgery, success rates, and rehabilitation process.;Data Sources: PubMed (1960-2014), MEDLINE (1960-2014), CINAHL with full text (1960-2014), SPORTDiscus full text (1960-2014), Science Direct (1960-2014), and Google Scholar were searched using the terms ulnar collateral ligament, elbow, baseball, reconstruction and treatment. Second, the term ulnar collateral ligament was combined with each of the following terms: surgery, Jobe technique, Docking technique, and rehabilitation. Third, cross-referenced citations were used from studies that included information not found in searches.;Study Selection: Studies were included based on the following criteria: 1) written in English or an English translation; 2) ulnar collateral ligament, baseball athletes, throwing athletes, surgical techniques, elbow, reconstruction, rehabilitation, or various forms of these terms were mentioned in the title of the study; 3) ulnar collateral ligament, baseball athletes, throwing athletes, surgical techniques, elbow, reconstruction, rehabilitation, or various forms of these terms were mentioned in the abstract; 4) ulnar Collateral ligament reconstruction and rehabilitation was the main focus of the study; 5) the study was an experimental study or cohort study. Studies were excluded on the following criteria: 1) they are not written in or translated into English; 2) studies do not involve the Jobe or Docking technique as a surgical option; 3) injury did not pertain to the UCL of the elbow.;Data Extraction: All studies that met the inclusion criteria were evaluated using the Coleman Methodology Score (CMS). Each study included was read first by each evaluator without the Coleman Methodology Score. The studies included were read a second time using the Coleman Methodology Score. Final score was within a range of 0 to 100. Once all studies have were read and evaluated, the evaluators\u27 met to compare scores. When discrepancies were found, the evaluators\u27 discussed the criterion in question and agreed on a final score.;Data Synthesis: Twelve studies met the inclusion criteria and were evaluated with the Coleman Methodology Score. The methodology scores ranged from 37-62, average score was 49.2 out of 100. Six studies scored fair and 6 studies scored poor on the CMS. Success between surgical techniques was inconclusive for all surgical techniques examined based on CMS scores.;Conclusion: The CMS scores ranged from fair to poor. It can be concluded that no recommendations can be made on what surgical technique is considered to be the best options for UCL reconstruction and that results may remain inconclusive

Evidence of a causal effect of genetic tendency to gain muscle mass on uterine leiomyomata

Uterine leiomyomata (UL) are the most common tumours of the female genital tract and the primary cause of surgical removal of the uterus. Genetic factors contribute to UL susceptibility. To add understanding to the heritable genetic risk factors, we conduct a genome-wide association study (GWAS) of UL in up to 426,558 European women from FinnGen and a previous UL meta-GWAS. In addition to the 50 known UL loci, we identify 22 loci that have not been associated with UL in prior studies. UL-associated loci harbour genes enriched for development, growth, and cellular senescence. Of particular interest are the smooth muscle cell differentiation and proliferation-regulating genes functioning on the myocardin-cyclin dependent kinase inhibitor 1A pathway. Our results further suggest that genetic predisposition to increased fat-free mass may be causally related to higher UL risk, underscoring the involvement of altered muscle tissue biology in UL pathophysiology. Overall, our findings add to the understanding of the genetic pathways underlying UL, which may aid in developing novel therapeutics.Peer reviewe