UCL Reconstruction

Ulnar collateral ligament (UCL) reconstruction surgery involves replacing a torn ulnar collateral ligament with a tendon from another part of your body. It is also referred to as Tommy John surgery. The UCL, also called medial collateral ligament, is located on the inside of the elbow and connects the ulna bone to the humerus bone. It is one of the main stabilising ligaments in the elbow, especially during overhead activities such as throwing and pitching. When this ligament is injured, it can end a professional athlete’s career unless surgery is performed.

The common symptoms associated with a UCL injury are pain on the inner side of the elbow, unstable elbow joint, numbness in the little finger or ring finger, and decreased performance in activities such as throwing baseballs or other objects.

Ulnar collateral ligament injury is usually caused by repetitive overhead throwing such as in baseball. The stress of repeated throwing on the elbow causes microscopic tissue tears and inflammation. With continued repetition, eventually the UCL can tear, preventing you from throwing with significant speed. If untreated, it can end an athlete’s professional career. UCL injury may also be caused by direct trauma such as with a fall, car accident or work injury. Other causes include any activity that requires repetitive overhead motion of the arm such as tennis, pitching sports, fencing and painting.

UCL injuries can be diagnosed with

• your medical history and
• physical examination, including a valgus stress test to assess for elbow instability.

Other tests such as X-rays and MRI scans may be ordered to confirm the diagnosis.

Your physician will recommend conservative treatment options to treat the symptoms associated with an UCL injury. However, if you are a professional or collegiate athlete, and wish to continue in your sport, surgical reconstruction is recommended instead.

Conservative treatment options that are commonly recommended for non-athletes include activity restrictions, orthotics, ice compression, medications, physiotherapy, and pulsed ultrasound to increase blood flow to the injured ligament and promote healing.

If conservative treatment options fail to resolve the condition and the symptoms persist for 6-12 months, your surgeon may recommend ulnar collateral ligament reconstruction surgery. UCL reconstruction surgery repairs the UCL by reconstructing it with a tendon from the patient’s own body (autograft) or from a cadaver (allograft). The most frequently used tissue is the palmaris longus tendon in the forearm. The basic steps for UCL reconstruction surgery include the following:

• The surgery is performed in an operating room under regional or general anaesthesia.
• Your surgeon will make an incision over the medial epicondyle area.
• Care is taken to move muscles, tendons and nerves out of the way.
• The donor tendon is harvested from either the forearm or below the knee.
• Your surgeon drills holes into the ulna and humerus bones.
• The donor tendon is then inserted through the drilled holes in a figure 8 pattern.
• The tendon is attached to the bone surfaces with special sutures.
• The incision is closed and covered with sterile dressings.

Finally, a splint is applied with the elbow flexed at 90 degrees.

After surgery, your surgeon will give you guidelines on care, depending on the type of repair performed and the surgeon’s preference. Common postoperative guidelines include:

• Elevate your arm above heart level to reduce swelling.
• Wear an immobilising splint or cast for 1-3 weeks.
• Apply ice packs to the surgical area to reduce swelling.
• Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
• Physiotherapy will be ordered that include strengthening and stretching exercises after the removal of the splint or cast.
• Professional athletes can expect a strenuous strengthening and range-of-motion rehabilitation program for 6-12 months before returning to their sport.
• Eating a healthy diet and not smoking will promote healing.

As with any major surgery there are potential risks involved. Majority of patients suffer from no complications following UCL reconstruction surgery; however, complications can occur and include infection, limited range-of-motion, nerve damage, causing numbness, tingling, burning or loss of feeling in the hand and forearm area, cubital tunnel syndrome and elbow instability.