Ulnar Collateral Ligament Reconstruction

The elbow is a very stable joint. The bone architecture provides 50% of the joint’s stability. The ligaments and the muscles surrounding the joint provide the rest of the joint’s stability. The main ligament stabilizer on the inside of the elbow is the ulnar collateral ligament (UCL) which is also known as the Tommy John ligament. This ligament is most commonly injured in baseball pitchers but it can occur in windmill softball pitchers, javelin throwers, gymnasts and wrestlers. This ligament stabilizes the elbow during when the arm is the late cocking and early acceleration phase of the throwing motion. Often pitchers feel a pop when they injure this ligament. However, the ligament can also gradually stretch out and cause pain with repetitive hard throwing. Pitchers with a UCL injury frequently complain of pain with throwing and loss of velocity.

Treatment usually starts with rest and physical therapy aimed at strengthening the shoulder and elbow muscles. Then, a gradual return to sport is allowed. For pitchers, a controlled throwing program allows a gradual return to hard throwing. A UCL injury does not interfere with the ability to do most athletic activities or activities of daily living; however, it can be difficult for baseball pitchers and other overhead sports participants to return to a high level of competition if the UCL does not heal. For those who have persistent pain after adequate rehabilitation and evidence of ligament injury on x-rays and MRI, surgery may be necessary to reconstruct the UCL. This is done with an incision on the inside of the elbow using a tendon from the forearm, the ankle or the knee. Patients are usually put into a splint for 7-10 days following surgery, and a supervised rehab program is started. This program includes light throwing at 4 months after surgery, and return to competition for pitchers usually takes 10-12 months.

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