Houston Methodist. Leading Medicine

Elbow FAQ

Question:

I've heard that the majority of athletes who have surgery to reconstruct their torn UCLs are able to get back to serious competitive play. Can you verify this for me? Is it really true?

Answer:

According to a recent report from surgeons at the Rothman Institute in Philadelphia and the Hospital for Special Surgery in New York City, the answer to your question is "yes." But there are a few qualifying statements to go with that "yes." The ulnar collateral ligament is on the medial (the side of the elbow that's next to the body) side of the elbow. It is a thick band of ligamentous tissue that forms a triangular shape along the medial elbow. The ulnar collateral ligament (UCL) can become stretched, frayed or torn through the stress of repetitive throwing motions. If it does not heal correctly the elbow can be too loose or unstable. The ulnar collateral ligament can also be damaged by overuse and repetitive stress, such as the throwing motion. From the way you posed your question, it sounds like this might be your situation. Sometimes an injury to the UCL can be treated conservatively (without surgery). The nonoperative approach can work well for patients who have a partially torn but not completely ruptured ligament. The conservative approach may also be recommended for patients who are not athletes and therefore not involved in activities that require overhead throwing. On the other hand, when there is a complete tear, overhead throwing athletes are not good candidates for conservative care. Studies have conclusively shown that reconstruction is definitely needed for these athletes if they want to return to full sports play. There are several different ways to perform this type of surgery. The surgeon's level of experience and expertise, the severity of the tear, and the health of the patient are all important factors in the outcomes. There are delicate nerve tissues in this area that must be moved without damaging or injuring them. The procedure is less invasive if it can be done arthroscopically. If it turns out you need a graft in order to reconstruct the ligament, then the procedure becomes a bit more complicated. The surgeon usually harvests graft tissue from some other area of your both. For the ulnar collateral ligament, either the gracilis tendon from the thigh or the palmaris ongus tendon from the hand is used. But if all goes well with the surgery, results from studies do suggest that the majority of athletes have good-to-excellent results. In the case of "good" results, athletes return to the sport of their choice but may not be able to play at the same level as before the injury. Some athletes have to change sports to avoid the repetitive motion and load that led to the injury in the first place. Those who experience "excellent" results return to full participation in the sport of their choice and at the same level as before the injury. Christopher C. Dodson, MD, and David W. Altchek, MD. Ulnar Collateral Ligament Reconstruction Revisited: The Procedure I Use and Why. In Sports Health. September/October 2012. Vol. 4. No. 5. Pp. 433-437.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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