Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes

Abstract

Nonoperative options for UCL injuries include guided physical therapy and biologic augmentation with platelet-rich plasma (PRP). In some patients, repair of the UCL has shown promising return to sport rates by using modern suture and suture anchor techniques. Proximal avulsion injuries have shown the best results after repair. Currently, there is growing interest in augmentation of UCL repair with an internal brace. The treatment of UCL injuries involves complex decision making. UCL reconstruction remains the gold standard for attritional injuries and complete tears, which occur commonly in professional athletes. However, nonreconstructive options have shown promising results for simple avulsion or partial thickness UCL injuries. Future research comparing reconstructive versus nonreconstructive options is necessary.

Medial elbow anatomy: A paradigm shift for UCL injury prevention and management

“…Finally, the findings of this study may be useful for improving the outcomes of UCL surgery. Although UCL reconstruction remains the gold standard for treating UCL injuries, there is growing interest in UCL repair with and without augmentation, which has the potential of reducing the time to recovery and the athlete's return to sport performance (Rebolledo et al, ; Clark et al, ). Historically, UCL repair has obtained good results for selected younger patients (Azar et al, ).…”

“…In addition, recent reports have shown favorable results for repair with augmentation, such as ligament plication, suture repair with bone anchors, or tape augmentation (Savoie et al, ; Mackay et al, ). Several reports showed that UCL repair with suture tape augmentation had the advantage of a quicker recovery time, decreased soft tissue damage, and better stability, compared with the repair and reconstruction technique (Dugas et al, ; Clark et al, ). However, a treatment decision for patients should include a consideration of the tissue quality of the UCL (Dugas et al, ).…”

Platelet-Rich Plasma: Review of Current Literature on its Use for Tendon and Ligament Pathology

“…Ulnar collateral ligament Injury to the medial ulnar collateral ligament (MUCL) occurs as a result of extraneous valgus loads and is common in overhead-throwing athletes [54]. A fully torn ligament or one that has not responded favorably to conservative treatment will be treated surgically; however, success rates have varied from 83 to 90% for a return to play by 9-12 months postsurgery [54].…”

“…Ulnar collateral ligament Injury to the medial ulnar collateral ligament (MUCL) occurs as a result of extraneous valgus loads and is common in overhead-throwing athletes [54]. A fully torn ligament or one that has not responded favorably to conservative treatment will be treated surgically; however, success rates have varied from 83 to 90% for a return to play by 9-12 months postsurgery [54]. A case study by Hoffman et al detailed the outcome of an MUCL reconstruction in a 25-year-old professional pitcher that was augmented with a dermal allograft reconstituted in PRP and mesenchymal stem cells [55].…”

Considerations of Conservative Treatment After a Partial Ulnar Collateral Ligament Injury in Overhead Athletes: A Systematic Review

“…15 Although outcomes have been favorable, UCL reconstruction (UCLR) usually requires a minimum of 10 to 16 months for full recovery with potential surgical risks and complications, such as fracture, inadequate healing, and nerve injury. 4,33 Thus, conservative treatment may be considered an option for returning an overhead athlete to play with a partial tear. 4 Moreover, properly identifying athletes who may successfully be treated conservatively can be a challenge because of factors involved in the treatment decision-making process.…”