Techniques for ulnar collateral ligament reconstruction in athletes

Abstract

The ulnar collateral ligament (UCL) is the primary restraint to valgus stress of the elbow. Symptomatic valgus instability secondary to ligament insufficiency is seen almost exclusively in overhead throwing athletes, particularly baseball pitchers. The valgus forces on the elbow during the late cocking and early acceleration phases of throwing are tremendous. Valgus loading of the medial elbow is transmitted mainly to the UCL, and may exceed its tensile strength. Instability resulting from UCL insufficiency alters the joint biomechanics, hinders the ability to throw, and may lead to secondary elbow pathology. Most overhead athletes who fail nonoperative measures require reconstruction of the ligament. The initial technique of UCL reconstruction resulted in moderate clinical success, but had a relatively high rate of complications, mainly involving the ulnar nerve. Modifications of the surgical technique in subsequent years have yielded more predictable results and fewer complications.