Variability of Rehabilitation Protocols for Ulnar Collateral Ligament (UCL) Reconstruction

Abstract

Ulnar Collateral Ligament (UCL) reconstruction is commonly performed in overhead throwing athletes. Rehabilitation after surgical intervention is important for recovery. The purpose of this study was to assess variability of publicly accessible UCL reconstruction rehabilitation protocols. Rehabilitation protocols were identified by searching the websites of orthopaedic surgery residency programs in the United States located from the Fellowship and Residency Electronic Interactive Database Access System. Private practice groups with publicly available UCL reconstruction protocols were also included. Twenty-eight protocols were included for review. Return to sport time was included in all 28 (100%) of the protocols with significant variability with a range of 8 to 48 weeks (mean 28 wks). Passive elbow range of motion (ROM) was recommended in only 9 (32%) protocols and 5 (56%) protocols recommended starting it at 2 weeks after surgery. Active ROM recommendation for elbow was included in 18 (93%) protocols, and 5 of 18 (28%) protocols recommended initiating active ROM at 6 weeks. Full elbow ROM recommendation was included in 26 (93%) protocols, and initiating full ROM at 6 weeks was recommended by 11 (42%) protocols. Brace use was recommended in 26 (96%) protocols and 18 (69%) protocols agreed on using a brace for 6 weeks. Elbow strengthening was recommended by 27 (96%) protocols and 14 (52%) protocols recommended starting elbow strengthening at 6 weeks. An interval throwing program was recommended by 23 (82%) protocols and 8 (35%) of those protocols recommended starting the program at 16 weeks. A high degree of variability was found among rehabilitation protocols following UCL reconstruction. The recommendation for time until returning to sport was highly variable. Some common themes were seen like the majority recommending bracing and interval throwing. However, the variability of the timing of these activities demonstrates the need for evidence-based rehabilitation standards following UCL reconstructions.