The collateral ligaments in the elbow secure the humerus, the upper arm bone to the bones of the lower arm, known as the radius and ulna. Specifically, the ulnar collateral ligament is situated on the inside of the elbow, anchoring the humerus to the ulna. The UCL ligament is critical for the stability and proper functioning of the elbow, particularly in the throwing motions seen in baseball pitchers.
Injuries to the UCL can occur from traumatic injuries and through overuse commonly seen in overhead athletes, such as baseball pitchers. Injury causes pain and dysfunction.
UCL injuries can be treated non-surgically, particularly in cases where the ligament is not completely torn or if the patient is not engaged in activities that place a high demand on the elbow. Non-surgical treatment is typically considered as the first line of management, especially for partial tears or less severe UCL. Athletes who desire to return to sports like throwing may choose surgical repair.
UCL repair with suture augmentation is a relatively newer technique designed to treat UCL tears. This procedure is an alternative to the traditional Tommy John surgery for some patients. Here is an overview of the process:
Traditional UCL Reconstruction vs. Repair with Suture Augmentation:
- Traditional UCL Reconstruction (Tommy John surgery): Involves replacing the torn ligament with a tendon graft taken from another part of the patient’s body or a donor.
- UCL Repair with Suture Augmentation: Involves repairing the patient’s own ligament and reinforcing it with a suture material rather than replacing it entirely. This can only be done if the quality of the torn ligament is sufficient for repair.
Ulnar collateral ligament repair is a surgical procedure used to repair a torn ulnar collateral ligament on the inside of the elbow. It is suitable for partial tears or less severe injuries where the ligament is still attached to bone.
Repair involves repairing the ligament which may involve reattaching it to the bone. A suture, often made of strong, durable material, is threaded through the ligament and bone to provide additional support as the ligament heals. The benefits include that the procedure is less invasive than reconstruction and may allow for faster recovery while preserving the patient’s natural anatomy.
Recent studies report that UCL repair with suture augmentation provides good clinical results. Direct repair restores the normal anatomy, eliminates the need for a graft, donor site injury and prolonged recovery times. The overall complications rate is low. The reoperation rate is 0% to 3.4%. The overall rate of return to play at the preinjury level or at a higher level than the preinjury level ranged from 67% to 93%. The mean time to return to play ranged from 6.7 to 17.6 months in some studies.
For the appropriately selected patient, UCL repair with suture augmentation without reconstruction is an option. It may be more appropriate for younger patients or those with specific injury types that make them suitable candidates for the procedure.
Postoperative treatment is immobilization for 7-10 days followed by a hinged elbow brace. Active range of motion is initiated at 2 weeks and full range of motion and strength training are initiated at 4 weeks. An interval throwing program is started at 3-4 months with a gold of return to play at 6-7 months.
UCL repair with suture augmentation represents an advancement in the treatment of UCL injuries that could provide certain patients with a faster return to athletic performance. However, patient selection is critical, and the decision between traditional reconstruction and suture-augmented repair should be made by your Silicon Valley Orthopedics surgeon based on the specific details of the patient’s injury and health status.
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At Silicon Valley Orthopedics, we treat athletes and non-athletes alike with cutting edge techniques and procedures as well as nonsurgical options that will help healing when time and patience are in order. Contact us to schedule a consultation at one of our offices in Fremont, Los Gatos or Menlo Park. We strive to provide all of our patients with world-class compassionate and personalized orthopedic care aimed at your specific needs.