National Football League Quarterbacks With Ulnar Collateral Ligament Injuries Have High Return-to-Play Rates, but Older Players Have Inferior Postinjury Performance

Abstract

Purpose: To characterize the epidemiology, mechanism (contact vs noncontact), management, and return-to-play (RTP) times for quarterbacks in the National Football League (NFL) who experienced ulnar collateral ligament (UCL) injuries. Methods: Using the Pro Sports Transactions Archive, NFL quarterbacks who sustained UCL injuries between 1991 and 2023 were identified. Age at time of injury, mechanism of injury (contact vs noncontact), management strategy, and RTP time were recorded. In addition, player performance metrics including games played, quarterback rating, completion percentage, touchdowns, and interceptions were examined for the season before injury through the second season after injury. Player performance analysis was assessed using principal component analysis, which is a dimensionality reduction statistical method that compresses the several performance metrics into a single value, the first principal component. Results: A total of 21 injuries in 20 players were identified. The mean age of quarterbacks at time of injury was 28.7 years (± 4.6 years standard deviation). Ten injuries occurred during contact with another player, and 11 injuries were noncontact. Most (n = 13) of UCL injuries were managed nonoperatively. Sixteen players achieved RTP, 4 of whom underwent repair or reconstruction (UCLR). Overall, the mean RTP time was 165.6 days (± 178.8 days standard deviation), but players who underwent UCLR had a longer average RTP time (359.0 days vs 98.25 days, P = .014). Injuries sustained after 2006 were associated with improved postinjury performance (P = .041), but older age at time of injury was associated with diminished postinjury performance (P = .048). Conclusions: NFL quarterbacks sustain more noncontact UCL injuries and are undergoing UCLR at greater rates than previously reported. Although RTP rates are high and players demonstrate improved postinjury performance for injuries sustained after 2006, older age at the time of injury is associated with worse postinjury performance. Level of Evidence: Level IV, therapeutic case series.