UCL Reconstruction in the Throwing Elbow

Abstract

The ulnar collateral ligament (UCL) of the elbow is the primary stabilizer to valgus stress and is most commonly injured in the overhead throwing athlete. First described in a javelin thrower in 1946, 1 UCL injury is now well recognized in sports medicine and has become the preeminent injury in professional pitchers. UCL insufficiency is usually managed surgically with UCL reconstruction or “Tommy John surgery,” named for the first professional pitcher treated by Dr Frank W. Jobe in 1974. 2 The operation is becoming increasingly prevalent especially in adolescent patients. 3 Using modern surgical techniques, the vast majority of patients are now expected to return to or exceed their previous level of play following UCL reconstruction. 4 This chapter outlines UCL anatomy, pathophysiology, patient evaluation and diagnosis, nonoperative management, surgical options, and describes current surgical techniques.