Primary Repair of Ulnar Collateral Ligament Injuries of the Elbow

Abstract

Injuries to the medial ulnar collateral ligament (MUCL can be devastating in overhead and throwing athletes. Prior to 1986 injury to this ligament was considered to be career ending. In that year, Dr. Frank Jobe reported on his initial experiences with reconstruction of the MUCL. His first case was pitcher Tommy John, who underwent what at that point was considered an experimental surgery to reconstruct the ligament using the palmaris longus tendon. The success of the classic “Tommy John” surgery in professional athletes has led most of these injuries to be managed by the same reconstructive technique. However, the injuries in young athletes do not appear to be the same as those sustained by professionals; one of the issues that led Dr. Jobe to utilize a reconstruction rather than a repair was the “wear and tear” of repetitive micro-trauma rather than a discrete area of injury. Fortunately in young, active athletes, the initial injury often is isolated to a single area, increasing the chance of both nonoperative and direct repair each being successful in allowing a return to sport. Unfortunately, there has been little focus on alternative treatment options in these young, nonprofessional athletes who continue to have instability despite conservative treatment and who wish to continue in sports. Many of these young athletes may have MUCL injuries isolated to one area in the proximal or distal end of the ligament that would seemingly allow a repair rather than reconstruction. Rather than extrapolate the data from professional athletes that the classic “Tommy John” operation is necessary for all of these young athletes to return to sports, we developed a protocol of repair in these players in which the ligament had a single area of injury on either the proximal end, distal end, or both in an attempt to minimize morbidity and loss of time and allow a more rapid return to sports. The indications for repair include a repairable injury (i.e., an injury to the ligament confined to the proximal or distal end of the ligament with or without a small fragment of bone) and a patient who desires to continue his throwing activity. In our initial study, 93 % (56 of 60) of these young (age range 13–23, avg. 16) athletes in the study returned to sports within 6 months (range 4–11.7 months) postoperatively at the same or higher level of competition.