Throwing athletes are frequently affected by medial ulnar collateral ligament (UCL) injuries and posterior elbow impingement. Individually, surgical surgery for each of these diseases is effective, with high rates of return to play. This study aims to report on the rates of return to play for individuals treated by the senior author with concurrent UCL reconstruction and arthroscopic posterior débridement. From January 2016 to September 2020, researchers analyzed all elbow medial ulnar collateral ligament surgeries conducted by the senior author. Inclusion criteria for a throwing athlete comprised an elbow medial ulnar collateral ligament operation with an arthroscopic posterior compartment débridement. Isolated UCL reconstruction surgery, non-primary surgery, and revision UCL reconstruction with either autograft or allograft were all exclusion criteria. Investigators determined the patients’ playing level after surgery by reviewing their charts and using publicly available information.

About 12 patients met both the inclusion and exclusion criteria. The average age was 24.27 years (standard deviation= 4.92). With an average return-to-play (RTP) time of 14.64 months (SD = 2.64 months), 10 of the 12 patients returned to play at the same level (4 MLB players, 1 Triple-A player) or higher (2 players from Single-A to Double-A, 1 player from NCAA Division I to Single-A, 1 player from Rookie League to Single-A, and 1 player from High School to NCAA Division I), 1 did not return to play, and 1 returned to play at a lower level. 11 of the 12 patients were pitchers, and 9 of the 11 pitchers had numbers before and after their UCL replacement. Before their UCL reconstructions, the pitchers had an ERA of 4.11±0.85, a WHIP of 1.42±0.26, a K/BB of 3.00±1.83, a K/9 of 8.801.14, and a total of 234.88316.74 innings pitched. After UCL restoration, their ERA was 5.24±2.18 (p=0.189), WHIP was 1.55±0.34 (p=0.379), K/BB was 2.15±0.98 (p=0.263), K/9 was 9.67±1.91 (p=0.293), and innings pitched were 138.71±162.97 (p=0.487). While surgical intervention to address both posterior impingement and UCL injury is relatively uncommon (8.5% of all UCL reconstructions performed by the senior author), the experience shows that primary UCL reconstruction with concurrent arthroscopic posterior decompression is a reliable, safe, and successful surgical treatment for patients with UCL injury and posterior impingement. The results show no significant difference in statistical performance in pitchers from before to after surgery.