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To assess simulated ulnar collateral ligament (UCL) graft length change, using surgically dissected anatomic landmarks, between multiple combinations of humeral and ulnar bone tunnels.Three equidistant humeral and ulnar tunnels were created at each UCL footprint of 10 cadaveric elbows. Suture was passed between 9 possible tunnel combinations for each elbow and affixed to an isometry gauge. Each elbow was moved through an arc of 0, 30, 60, 90, and 120° for each tunnel combination. Changes in isometry gauge spring displacement (and, in effect, tension) were recorded.There was an overall significant effect (P.0001) of tunnel placement at all degrees of flexion. Pairwise comparisons revealed increases in displacement between the central and posterior tunnel positions of the medial epicondyle, with significant differences (P = .0009) occurring when paired with both the central and posterior aspect of the sublime tubercle. Significant differences (P.0001) were noted between the anterior and posterior humeral tunnel positions.Simulated UCL graft isometry is dependent upon optimal bone tunnel placement. No significant differences were noted between ulnar tunnel locations when paired with any given humeral tunnel. Conversely, deviation anterior or posterior from the centroid of the UCL footprint on the medial epicondyle significantly affected isometry at all degrees of flexion recorded with the greatest amount of displacement occurring with pairi4ng of posterior tunnels on both the humeral and ulnar footprints.This anatomic study highlights the importance of medial elbow bone tunnel placement and its effect on simulated UCL graft isometry.

Purpose To determine common mechanisms of anterior cruciate ligament (ACL) injury in baseball players and to quantify the rate of return to play after primary surgical reconstruction and review intermediate clinical outcomes. Methods Surgical injuries involving the ACL in youth, high school, collegiate, and professional baseball players were queried for an 11-year period (2001 to 2011). Over the study period, 42 baseball players were identified who had undergone arthroscopically assisted primary ACL reconstruction by 1 of 3 attending surgeons. Retrospective chart review was performed for all 42 patients to evaluate variables of age, level of competition, position, mechanism of injury, graft choice, and associated meniscal injuries. Twenty-six patients were reached for telephone survey and International Knee Documentation Committee questionnaire and they answered questions about their original injury and playing history. Results The most common mechanism of injury was fielding, followed by base running. Infielders and outfielders (32% each) were the most commonly injured position, followed by pitchers (29%). Among the 32 players for whom it could be determined, 30 (94%) were able to return to playing baseball at a mean follow-up of 4.2 years (range 1.0 to 9.9 years). The mean International Knee Documentation Committee score was 84.0 (range 63 to 91). Among the 26 patients contacted for telephone interview, no one required revision ACL surgery, but 3 required a subsequent procedure for meniscal tear. Twenty-five patients (96%) denied any episodes of instability in the knee after reconstruction. Conclusions The overwhelming majority of baseball players that sustain ACL injuries do so while fielding or base running. Outfielders are significantly more likely than infielders to suffer ACL injuries while fielding versus base running. The results with respect to return to play are promising, as nearly all patients were able to return to baseball and none required a revision ACL surgery at a mean follow-up of 4.2 years. Level of Evidence Level IV, therapeutic case series.