Sex Differences in Elbow Ulnar Collateral Ligament Injuries: A Retrospective Analysis

BACKGROUND: The incidence of UCL injuries has increased considerably and is well documented in male-focused literature. Although women are not immune to UCL injuries, limited work has explored potential sex-specific differences in UCL mechanism of injury, clinical presentation, care pathway, or return to play. The purpose of the present study was to evaluate patterns of elbow UCL injury in male and female athletes via MRI review.METHODS: Retrospective chart review of diagnosed elbow UCL injuries at a single sports medicine institution from January 2015- January 2022 was performed. Inclusion criteria were as follows: (1) patients 15-35 years of age, (2) diagnosis of an elbow UCL injury, (3) athlete, (4) MRI of elbow at the time of injury, (5) patient documentation records with demographic information. Male and female groups were compared for differences in injury patterns and the presence of concurrent injuries. A secondary analysis assessed demographic differences between the two cohorts. To determine if there were statistically significant differences between males and females, t-tests or Mann-Whitney U tests were used for numerical variables based on distribution, while chi-square or Fisher’s exact tests were used for categorical variables. RESULTS: Of 1,068 patients diagnosed with a UCL injury during the study window, 168 patients met inclusion criteria (113 (67%) males and 55 (33%) females). The average age in both groups was 17.9 ± 2 years. No statistically significant differences were observed with regard to handedness, injury year, or injury month. When comparing injury-related clinical factors between male and female patients, statistically significant differences were discovered for injury onset, UCL grade, and tear location (all p<0.001). Males had a higher rate of bony edema (63% vs. 26%; p<0.001). No significant differences were found with other associated injuries. CONCLUSION: This present study demonstrates that sex-specific differences exist in UCL injury patterns – including onset of UCL injury, grade, and tear location. We also found that MRI findings, symptom duration, and management strategies differed between male and female athletes. Female athletes more commonly presented with chronic UCL injuries, many of which displayed no significant findings on MRI imaging. The results of this study suggest that sex-specific differences in UCL injury occurrence and presentation exist. Further research is needed to better inform the care and treatment of UCL injuries in both male and female athletes.