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Prevention and Repair of Elbow Ligament Injuries in Young Athletes

Injury to the ulnar collateral ligament (UCL) can result in a painful, unstable elbow. This injury occurs in response to chronic overloads along the inside of the elbow. It is on the rise in athletes.

Young players who train and play at a level beyond their anatomic maturity are especially at risk. As a result, the ulnar collateral ligament can become stretched, frayed or torn. The stress of repetitive throwing motions for throwing athletes or weight-bearing for cheerleaders and gymnasts can cause this problem.

Efforts are being made to prevent UCL injuries. Research is focused on finding ways to improve biomechanics and core strengthening. The goal is to decrease stress on joints at risk (especially immature joints in the young athlete). But if the ligament tears (partially) or ruptures (completely), then surgery may be needed.

Reconstruction of the ligament with a tendon graft along the inside of the elbow is one treatment option. But ways to repair the ligament are being investigated. According to this study, ligaments with a single area of injury can be repaired rather than reconstructed. In other words the ligament is only torn at one end or the other. Repairing the damaged ligament may mean a quicker recovery and faster return to the playing field for the athlete.

All patients in this study were younger than 22 years of age. All had sustained a medial (inside the elbow) UCL injury. Baseball players, basketball players, gymnasts, cheerleaders, and other overhead throwing sports athletes were included.

Surgery was done to repair the damaged ligament. Arthroscopy was used to examine the area. At the same time, the surgeon was able to remove any frayed tissue or soft tissue fragments that didn't belong. The tear was located and repaired. Holes were drilled in the bone. The torn end of the ligament was pulled through the holes and secured with absorbable suture anchors.

Patients were followed for up to five years. Results were measured by function, patient satisfaction, and return to sport. Complications and problems after surgery were noted. Most of the athletes (93 per cent) were back in action within six months.

The authors conclude that repairing a medial UCL tear is possible with young athletes. There is less damage to the joint since they have not been participating in sports very long. Results of the repair are improved because of this.

This study showed that it is not always necessary to reconstruct an unstable elbow with a tendon graft. For patients with this specific kind of ligament injury, repair is quite successful. An agressive rehab program that's sports-specific is recommended. As long as the elbow remains in a brace during sports-prep, the authors say the recovery process can be speeded up for these injuries.

References: Felix H. Savoie III, MD, et al. Primary Repair of Ulnar Collateral Ligament Injuries of the Elbow in Young Athletes. In The American Journal of Sports Medicine. June 2008. Vol. 36. No. 6. Pp. 1066-1072.

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