Ulnar Collateral Ligament Injury (UCL) injury, what surgery works?

Damage to the ulnar collateral ligament (UCL) in overhead (throwing) athletes was once a career-ending injury. But surgery to reconstruct the soft tissue was discovered in the 1980s. And the technique has improved over the years. Today, many of the affected athletes return to their sport. And they do so at a previous or higher level of participation.

In this article, surgeons from Columbia University in New York conduct a systematic review of surgical treatment for acute (recent) UCL injuries. They reviewed all published reports of UCL reconstruction in overhead athletes. The goal was to find out which surgical methods worked best.

Overhead athletes included baseball pitchers, javelin throwers, and tennis players at all levels of competition. Some were high school, others were recreational athletes. Some were at the college or professional level. Most were males between the ages of 17 and 24 years.

Various surgical approaches were described and compared. In the standard procedure, a tendon is harvested from some other part of the body. The donor tissue is used to replace the ruptured ligament. Tunnels are drilled through the humerus (upper arm bone). The graft is placed through the tunnels and attached to the bone. The graft may be attached using a figure-of-eight or a docking technique.

Success of the procedure was measured by the ability of the athlete to return to a preinjury level of play. Results are graded into categories of excellent, good, fair, or poor. A specific rating system called the Conway-Jobe rating was used to decide which category each athlete was in.

The overall results showed 83 per cent of the athletes had an excellent result. Excellent was defined as competition at the same (or higher) level than before the injury for more than one year. About 10 per cent of the players had complications after surgery. The most common problem was ulnar neuropathy. Damage to the ulnar nerve left some patients with persistent numbness, tingling, and other sensory changes.

The authors report that some surgical techniques seem to produce better results than others. The method of graft fixation, placement of tunnels through the bone, and approach to the soft tissues around the elbow made a difference. Surgical methods designed to decrease handling of the ulnar nerve also had lower rates of neuropathy.

This systematic review has shown us how much improvement in results has occurred with new graft fixation techniques. Surgeons will continue to modify methods used to repair a UCL injury. The ability of overhead athletes to return to competitive play will likely continue to improve as well.

References: Mark A. Vitale, MD, MPH, and Christopher S. Ahmad, MD. The Outcome of Elbow Ulnar Collateral Ligament Reconstruction in Overhead Athletes. In The American Journal of Sports Medicine. June 2008. Vol. 36. No. 6. Pp. 1193-1205.