Ulnar Collateral Ligament Reconstruction
By
“
By: Dr. Richard “”Lance”” Snyder
Ulnar Collateral Ligament Reconstruction: Intro
The first ulnar collateral ligament reconstruction (UCLR) was performed by Dr. Frank Jobe on Tommy John , a professional baseball pitcher with The Los Angeles Dodgers, in 1974. This is where the term Tommy John Injury began. Up to that time, elbow sprains or tears of the ulnar collateral ligament were often career ending at the very least debilitating. Primary repair outcomes were not good in this elite population and the surgery was groundbreaking. Since that time ulnar collateral ligament reconstruction has become the gold standard for UCL tears in the elite athlete.
Recent literature has shown an increased incidence in ulnar collateral ligament reconstruction in high school, collegiate and professional pitchers. This may be due to the success of the operation or the increase in injuries. Studies have shown that upper extremity injuries account for greater than 45% injuries in NCAA Baseball players.
In a study of NCAA baseball players 134 players had surgery in one year. In a study looking at the year 2018, 25 % of major league pitchers had undergone ulnar collateral ligament reconstruction at some point in their careers. In pitchers 15- 19 the trend is increasing for ulnar collateral ligament reconstruction about 6 percent a year. In one study the high school age group accounted for over fifty seven percent of ulnar collateral ligament reconstruction surgeries.
To learn more about throwing injuries and their rehab, please read this Baseball Article.
![]()
Image of UCL Pain
Anatomy of UCL
There are three bony articulations in the elbow; radio-capetellar, proximal radio-ulnar and ulnotrochlear. Bony articulations account for 50% of elbow stability and soft tissue restraints account for 50% of stability. The soft tissue restraints are the flexor pronator mass(primarily flexor carpi ulnaris), ulnar collateral ligament and the elbow capsule. The Ulnar collateral ligament is made up of the anterior bundle (most important), posterior bundle and transverse. The cull is about 24.5mm on average and is thicker in the throwing dominant side 6.2 mm compared with the non-dominant side 4.5mm. The throwing side tends to be more lax. Blood supply is much denser proximally with the distal end being much more hypo vascular.
If you would like to learn more about Throwing Injuries in the Elbow, this VIDEO may help.
How Do You Examine an Elbow for a UCL Tear?
This begins with a thorough history. The athlete is questioned when they felt pain in the pitching motion. They are questioned about what types of pitches the use? How many any teams they are on? Are they a year-round player? Have they been clocked by a radar gun? These factors have been associated with elbow pain and UCL injury. We then perform a physical exam. We check the flexibility and core strength. We also check the flexibility of the hips and spine. Hip injuries have been associated with UCL tears. We also check the shoulder range of motion and strength. Last, we examine the elbow. We look at range of motion (the dominant side is often lacking at least five degrees extension), elbow laxity, muscular strength, area of tenderness and last we examine the ulnar nerve.
How to You Test for a UCL Tear?
MRI is the test of choice. We often order arthrogram with the MRI. Ultrasound can help in the diagnosis. Primary films are always ordered to assess the bony architecture.
Ulnar Collateral Ligament Reconstruction in Baseball Athletes
Non-Operative Treatment for UCL Injury
A period of rest is always indicated. We try physical therapy with strengthening as well as stretching. It is important to address of the deficits in the kinetic chain during this period. Success has been reported with platelet rich plasma injections in partial tears. Proximal partial tears may do better then distal or mid substance complete tears.
Operative Treatment for UCL Tear
Primary repair has not had great results in the elite athlete. UCLR can be performed several different ways. Traditionally a bony tunnel is made in the sublime tubercle on the ulna. On the humeral side a “y” tunnel is made, and a graft is passed in a figure of eight fashion. Traditionally the palmaris longus is used. If a palmaris is not available, the gracilis or semitendinosis can be used. Although, some reports have indicated problems with using hamstring grafts. Other techniques involve the docking procedure, the Dane TJ or button placement on side of the graft. The Docking procedure currently has the highest success rate in most studies.
Rehab After Tommy John Surgery
We employ a protocol for return to throwing. After range of motion and strength have been achieved then staged return to throwing program is employed. Often we are asked what is the total elbow ligament surgery recovery time? This typically takes eleven to twelve months and the athlete may not fully recovered till sometime after this. Every athlete is different in how they heal from this surgery. Another major factor is related to their previous biomechanics when throwing.
Related Articles: Throwers Ten Exercises, Torn Elbow Tendon and Basic Throwing Mechanics.
Results after Recovery from UCL Reconstruction
Surgery for a torn UCL in a thrower is typically highly successful with 80-90 % return to previous level of sport.
To schedule physical therapy appointments at JOI Rehab, please call 904-858-7045. JOI Rehab has proven return to baseball programs from clinicians with years of baseball rehab experience.
If you have a UCL tear, or another throwing injury, then JOI has a team of experienced Physicians that can get you back in the game. Call 904-JOI-2000, schedule online, or click the link below to book your appointment today!
ASAP Injury appointments are available and Telehealth visits are offered by request.
”