Operative Treatment of Ulnar Collateral Ligament Injuries of the Elbow in Athletes

Abstract

Over a 6-year period, the senior author (JRA) performed 91 ulnar collateral ligament reconstructions (N = 78) or repairs (N = 13). All patients were male and between the ages of 15 and 39 years (average, 21.6). Thirty-seven patients (41%) were professional baseball players, 41 (45%) were collegiate baseball players, and 7 (7.7%) were high school or recreational players. Subcutaneous ulnar nerve transposition with stabilization of the nerve with fascial slings of the flexor pronator mass was performed in all patients, and additional procedures were performed in 27 patients (29.7%), including 22 excisions of posteromedial olecranon osteophytes. Average follow-up was 35.4 months. Ten patients had preoperative ulnar nerve symptoms, nine of whom had complete resolution of symptoms after surgery. Complications occurred in eight patients. The average time from surgery to initiation of the interval throwing program was 3.4 months, and the average time to return to competitive throwing was 9.8 months. Sixty-seven patients (74%) were available for follow-up; of these, 53 (79%) had returned to their previous levels of competition or to a higher level. Reconstruction of the ulnar collateral ligament, with transposition and stabilization of the ulnar nerve and appropriate rehabilitation, was found to be effective in correcting medial instability of the elbow and allowed most athletes to return to previous levels of play in less than 1 year.

Magnetic Resonance Imaging of the Throwing Elbow in the Uninjured, High School–Aged Baseball Pitcher

“…A number of adult throwers who undergo resection of posterior olecranon osteophytes to address valgus-extension overload later require surgical UCL reconstruction, with an initial ligamentous laxity contributing to the formation of the osteophyte. 1,2,8 Thus, it is possible this subgroup of asymptomatic high-school pitchers who have multiple abnormal MRI findings may be at greater risk for subsequent elbow injury. This hypothesis, however, must be confirmed with longitudinal follow-up.…”

The Effects of Elbow Bracing on Medial Elbow Joint Space Gapping Associated With Repetitive Throwing in High School Baseball Players

“…13 Microtrauma from repetitive tensile stress overloading the ligament causes inflammation and microscopic tears in the ligament and can eventually lead to ligament attenuation or failure. 4,10,24 …”

Chronic medial instability of the elbow

“…Unicortical reaming over a guide pin using either a 4.5 mm or a 5.0 mm reamer is performed. The graft is then attached to an interference screw via a suture through the screw using a previously described technique 33 and then manually inserted into the ulnar tunnel.…”