Ulnar Collateral Ligament Repair of the Elbow-Biomechanics, Indications, and Outcomes.

Abstract

Traditionally medial elbow injuries in overhead athletes have been treated with ulnar collateral ligament (UCL) reconstruction as first described by Dr. Frank Jobe. Recent literature has shown favorable outcomes in select patients treated with UCL repair. Newer techniques utilizing suture augmentation demonstrate biomechanical profiles as good or better than the native state and/or reconstruction. This review aims to evaluate these biomechanical studies and the clinical outcomes of ulnar collateral ligament repair with suture augmentation. UCL repair has favorable outcomes in select patients with specific tear type patterns. Clinical outcomes have shown return to play rates of 92-97% with mean time of 2.5-6months post-operatively. Biomechanical data comparing UCL repair to reconstruction techniques have shown improved resistance to common forces applied to the elbow during overhead activities. Additionally, suture tape augmentation dramatically improves stability of ligament repair without over-constraining the elbow. Initial ulnar collateral ligament repair data was poor, and thus UCL reconstruction became the mainstay of treatment for overhead athletes. Recent studies evaluating the biomechanical properties as well as clinical outcomes have demonstrated favorable data when UCL repair is performed. When considering the drawbacks of a prolonged recovery associated with reconstruction, UCL repair is a viable option in select patients.