APEX Elbow Mastering Surgical Techniques for Clinical Success-UCL Instability, Reconstruction versus Repair

Video Transcription

Video Summary

Glenn Ross, an orthopedic surgeon from Boston, reviews the evolution of ulnar collateral ligament (UCL) treatment in throwing athletes and frames a debate around reconstruction versus repair. He emphasizes that UCL injuries have become far more common over recent decades and that management requires understanding risk factors (especially throwing velocity), year-round play, mechanics, and the entire kinetic chain. Diagnosis should rely primarily on history and physical exam, including careful assessment of ulnar nerve symptoms and provocative valgus testing; imaging typically includes X‑rays and MRI, with panelists discussing contrast vs non-contrast MRI.<br /><br />Ross advocates initial nonoperative management for most patients—rest, rehabilitation, and sometimes PRP, though its benefit remains unproven. He reviews operative options from the classic Jobe reconstruction to the docking technique and other less-used methods, noting concerns such as ulnar neuropathy and graft choices.<br /><br />The talk’s main focus is the rising use of UCL repair with internal brace augmentation, popularized recently by Dugas but foreshadowed by earlier Savoie data. Ross reports shifting to ~95% repairs in selected primary cases (especially proximal or distal avulsions with good tissue), citing smaller incisions and faster return-to-play timelines, while acknowledging the need for broader outcome data and careful rehab and technical tensioning.

Asset Caption

Moderator: Glen Ross, M.D.

Keywords

ulnar collateral ligament

UCL injury

throwing athletes

UCL reconstruction

UCL repair

internal brace augmentation

return to play