From “Career-Ending” to Comeback: Ulnar Collateral Ligament Reconstruction for Throwing Athletes
A Second Chance: Dr. Frank Jobe and the Birth of Tommy John Surgery
The ulnar collateral ligament (UCL) is the primary restraint to stress across the inside of the elbow. Prior to the surgery pioneered by Dr. Frank Jobe (pictured above), an injury to the UCL was essentially career-ending for overhead athletes. The surgical techniques of UCL reconstruction have continuously evolved to improve the prognosis for the highly competitive athlete with an UCL injury. Dr. Jobe performed the first ulnar collateral ligament reconstruction of the elbow in 1974 on Los Angeles Dodgers pitcher Tommy John.
UCL Injury: Recognizing the Signs and Symptoms of Elbow Trouble
- Pain or a “pop”on the inside (medial side) of the elbow
- Swelling or “tightness” on the inside of the elbow
- Numbness/tingling in the ring and small finger with throwing
- Loss of velocity or control
Rest, Ice, Brace, and More: Treating UCL Injuries Before Surgery
- Rest – stop any throwing activities to allow the ligament to heal
- Ice – decrease the inflammation surrounding the ligament
- Bracing – provide stability to the elbow and prevent any unnecessary strain on the ligament
- Injections – platelet Rich Plasma (PRP) may augment the healing potential for partial tears
- Therapy – designed to strengthen the muscles surrounding the elbow and improve shoulder and elbow range of motion and increase core and leg strength
- Pitching Mechanics – improving pitching mechanics can help avoid injuries in the future
Are You a Candidate? Consult Dr. Burgmeier for Expert UCL Injury Care
An incision is made on the inside of the elbow to expose the ulnar collateral ligament. A graft of tissue is take from the forearm or leg to create a new ligament. The old ligament is left in place with the new ligament laid over the top of it in a figure-of-eight fashion. The new ligament is weaved through bone tunnels in the elbow. The surgery is an outpatient procedure and lasts 1-2 hours.
The majority of cases will resolve with the above treatment measures provided that they are faithfully followed. In the persistent case, the use of a local steroid injection may be considered. Additional treatment including high intensity shock wave therapy (ie Ossatron) is a noninvasvive option for refractory cases. It is only in the extremely rare case that consideration of surgical intervention is necessary.
Back in the Game: Returning to Your Sport After Successful UCL Reconstruction
- You will have a splint for 5-7 days
- Sutures will removed after 10-14 days
- Therapy will start once the splint is removed
- Throwing program will begin at 4 months
- Return to play is typically 12-18 months