UCL (Ulnar Collateral Ligament) Injuries in Throwers: There May Be an Alternative Option

By Dr. Tyler Meyers PT, DPT

Over the last few decades, UCL injuries in throwing athletes have become synonymous with UCL reconstruction surgery (also known as Tommy John). With increasing incident rates of Tommy John surgery in all ages, it is being defined as an epidemic in sports medicine. To put it in perspective, 22-26% of all injuries in the MLB are elbow-specific with 25% of all MLB pitchers having had Tommy John surgery prior. Even at the high school levels there has been a drastic increase in UCL reconstruction surgery with the state of New York having seen a 193% increase over the last 10 years. In the past the only surgical option for a UCL injury was a full reconstruction of the ligament. While the surgery has about an 83% successful return-to-sport, the length of the recovery can become challenging with an average of 11.6 months before return-to-sport.

Over the last few years, an alternative operation for UCL injuries has gained more attention. This procedure is called an Internal Brace UCL repair and has a substantially shorter recovery time for return-to-sport. The internal brace can be used as an alternative option if:

· Partial or complete tears at origin or distal insertion of the UCL with good ligament tissue.

· Good joint stability is present and there is high-quality native ligament tissue.

If the athlete is a possible candidate for the Internal Brace procedure, they will still be counseled/educated on the Internal Brace and full UCL reconstruction. The decision on which surgery will proceed can only be made intraoperatively (in surgery) from direct visual assessment of the UCL tissue by the surgeon. Thus far the Internal Brace procedure has shown significantly greater resistance to gapping with valgus stress (stress common with throwing) compared to UCL reconstruction. It has also been seen that the Internal Brace replicates failure strength of the traditional UCL which may represent the surgery as a viable option for younger patients also.

Following the Internal Brace surgery, physical therapy will be initiated consisting of five phases progressing to competitive throwing at 5 months (compared to 11.6 months for Tommy John. The table below shows the progression of an athlete in physical therapy for both the Internal Brace procedure and Tommy John full UCL reconstruction.

*All rehabilitation phase progression are averages and may be subject to change based on individual presentation.

For more information on physical therapy following an elbow injury please contact us at (719)-344-9497

For more specifics on the Internal Brace procedure please visit: https://www.arthrex.com/elbow/ucl-internalbrace-ligament-augmentation-repair

References

1. Wilk KE, Arrigo CA, Bagswell MS, et al. Repair of the ulnar collateral ligament of the elbow: rehabilitation following internal brace surgery. JOSPT. 2019;49(4):253-261