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

PurposeThe purpose of this study was to characterize the epidemiology, mechanism (contact versus non-contact), management, and return to play times for NFL quarterbacks who experienced UCL injuries.MethodsUsing 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 non-contact), management strategy, and return to play time (RTP) were recorded. Additionally, player performance metrics including games played, quarterback rating, completion percentage, touchdowns, and interceptions, were examined for the season before injury through the second season post-injury. Player performance analysis was assessed using principal component analysis (PCA), which is a dimensionality reduction statistical method that compresses the several performance metrics into a single value, the first principal component (PC1).ResultsA total of 21 injuries in 20 players were identified. The mean age of quarterbacks at time of injury was 28.7 years (SD = ± 4.6 years). Ten injuries occurred during contact with another player and 11 injuries were non-contact. The majority (13) of UCL injuries were managed non-operatively. Sixteen players achieved RTP, four of which underwent repair or reconstruction (UCLR). Overall, the mean RTP time was 165.6 days (SD = ± 178.8 days), but players who underwent UCLR had a longer average RTP time (359.0 days v. 98.25 days, p = 0.014). Injuries sustained after 2006 were associated with improved post injury performance (p = 0.041), but older age at time of injury was associated with diminished post injury performance (p =0.048).ConclusionsNFL quarterbacks sustain more non-contact UCL injuries and are undergoing UCLR at higher rates than previously reported. Although RTP rates are high and players demonstrate improved post injury performance for injuries sustained after 2006, older age at the time of injury was associated with worse post injury performance.