Question:Our college-aged son is having problems with his arm from a baseball injury. We're looking into possible surgery to reconstruct the ulnar ligament. How well does this treatment work? Will he be able to get back on the team? His college scholarship depends on it.
Answer:Ulnar collateral ligament (UCL) injuries of the elbow are common among overhead throwing athletes. Baseball pitchers, javelin throwers, and tennis players are affected most often. But reports of UCL tears are on record for wrestlers, cheerleaders, basketball players, and hockey players.
Most athletes try a course of nonoperative care first before considering surgery. Six weeks to three months of conservative care can get some athletes well on their way to returning to their sport. The full rehab program can take four to six months (or more) and shouldn't be rushed.
But when rehab doesn't work, then surgery may be the next step. Whenever possible, the surgeon will repair the torn ligament. A simple tear that's present only at one end of the ligament can be stitched back in place. The rehab process is the same but it's delayed until the ligament has time to heal.
If there is widespread damage to the ligament, then reconstructive surgery may be needed. A tendon graft is used to replace the ligament. There are various graft fixation methods used to accomplish this. Some are more successful than others.
Overall, the success rate for UCL reconstruction is around 85 per cent. This means that 85 per cent of the players are able to return to a level of participation that is equal to (if not better) than their preinjury play.
The 15 per cent who are left may return to their sport but at a lower level than before the injury. Some athletes choose not to return to sports at all. Others are unable to do so. In about 10 per cent of all cases, nerve damage results in numbness, tingling, and other sensory changes in the elbow and/or forearm. This can be temporary or permanent.Mark A. Vitale, MD, MPH, and Christopher S. Ahmad, MD. The Outcome of Elbow Ulnar Collateral Ligament Reconstruction in Overhead Athletes. In The American Journal of Sports Medicine. June 2008. Vol. 36. No. 6. Pp. 1193-1205.
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