AOSSM/AANA Specialty Day 2020-UCL Repair in the Elbow - Not Doing It

UCL Repair in the Elbow - Not Doing It - Here’s Why

Pdf Summary

This presentation by Dr. Michael G. Ciccotti from the Rothman Institute reviews the operative treatment options for ulnar collateral ligament (UCL) injuries in throwing athletes. Two main surgical treatments explained are UCL reconstruction and UCL repair, with a focus on their evolving roles.<br /><br />Historically, UCL reconstruction—using techniques such as Jobe’s figure-of-8 and the docking procedure—has been the standard with reported success rates between 63-95%, and approximately 10% complication rates, primarily ulnar neuropathy. Research shows no definitive superiority between the Modified Jobe and Docking techniques, with both providing comparable functional outcomes and return-to-play rates. Ongoing prospective randomized studies continue to evaluate these methods further.<br /><br />Recently, UCL repair augmented with an Internal Brace—a collagen-coated tape device—has emerged as a promising alternative particularly for younger athletes with acute proximal or distal UCL avulsions and healthy ligament tissue. Biomechanical studies suggest that UCL repair with the Internal Brace provides comparable strength and stability to reconstruction, with enhanced resistance to gapping under low cyclic loads. Early clinical outcomes show high return-to-play rates (around 92-96%) at an average of 6-6.7 months post-surgery, with good functional scores and low complication or reoperation rates, though longer follow-up and comparison studies are needed.<br /><br />The choice between reconstruction and repair depends on patient factors: reconstruction is favored for high-level throwers with degenerative/attritional UCL changes, while repair is considered for younger, physiologically healthy ligaments with avulsion injuries, often in non-elite athletes. The debate is not about which is best universally but how to best integrate each into treatment algorithms based on injury type and patient characteristics.<br /><br />In summary, UCL reconstruction remains the gold standard, but UCL repair with augmentation shows potential for certain patient subsets, emphasizing the need for continued focused research to optimize care and outcomes for throwing athletes with UCL injuries.

Keywords

Ulnar collateral ligament

UCL reconstruction

UCL repair

Internal Brace augmentation

Throwing athletes

Jobe's figure-of-8 technique

Docking procedure

Return-to-play rates

Ulnar neuropathy complications

Biomechanical studies