Second Surgery for Injured Elbow Ligament in Baseball Players

The medial collateral ligament (MCL) can become stretched, frayed, or torn through the stress of repetitive throwing motions. Professional pitchers have been the athletes treated most often for this problem. The word medial means it's on the inside of the elbow (closest to the body). Sometimes it's also referred to as the ulnar collateral ligament (UCL).

Treatment for a torn or ruptured ligament is surgery to repair or reconstruct the ligament. The procedure works well. Many athletes are able to return to play even better than before. But in a small number of pitchers, the ligament tears again. A revision (second) surgery may be needed.

In this study, the results are presented for 15 male ball players who had revision surgery for reinjury of the medial (ulnar) collateral ligament. The authors report a high rate of complications after the second surgery. Scarring and adhesions were much more common than after the first procedure.

The number of athletes able to return to play was much lower after a revision operation. There was a high rate of complications due to technical difficulties during the procedure. Bone fractures, nerve pain, and failure of the tendon graft used to replace the ligament occurred in 40 per cent of the athletes in this study.

Some players may not be willing to go through the long and difficult rehab required after a second operation. This is especially true when the outcome is unpredictable. Sometimes it's difficult to advise the player about what to do. There's no way to know in advance if the operation will be successful. More studies are needed to help in this decision-making process.

References: Joshua S. Dines, MD, et al. Revision Surgery for Failed Elbow Medial Collateral Ligament Reconstruction. In The American Journal of Sports Medicine. June 2008. Vol. 36. No. 6. Pp. 1061-1065.