What Is Elbow UCL Reconstruction?
Overuse or traumatic injuries to the elbow’s ulnar collateral ligament (UCL) are some of the most common elbow conditions, especially for anyone who does a lot of overhand throwing. The UCL sits on the inside of the elbow and connects the humerus (upper arm bone) to the ulna, which is one of the two bones of the forearm. Symptoms of a UCL tear–called a sprain–include pain, occasional tingling and numbness at the elbow, and a feeling of looseness or weakness of the arm. Often, throwing athletes can’t throw as hard and their elbows become easily fatigued.
UCL reconstruction is one method of treating UCL injuries. The surgery–also known as Tommy John surgery, after a Los Angeles Dodgers pitcher who had the first successful surgery in 1974–involves placing a bone graft over the damaged ligament to encourage the body to heal itself.
Reasons for UCL Reconstruction
UCL sprains are often overuse injuries, meaning that degradation of the ligament happens over months or years. Athletes in sports that require overhead movement are at particular risk for UCL sprains. These include pitchers, quarterbacks, javelin throwers and tennis players. People may also have acute UCL sprains or tears after a traumatic injury such as an elbow dislocation.
Candidates for UCL Reconstruction
UCL reconstruction surgery is usually an option when more conservative treatments–physical therapy, rest, anti-inflammatories, platelet rich plasma (PRP) injections and others–have failed. Certain people may be candidates for ligament repair, depending on the location and severity of the tear as well as the person’s plans for athletic activity and throwing.
UCL reconstruction is an outpatient procedure, meaning patients do not usually need to spend the night in the hospital. The surgery generally takes 60 to 90 minutes to complete.
In this surgery, the UCL is reconstructed, most often using a tendon from the patient’s own body. That tendon usually comes from the forearm, the hamstring or the big toe. This is called a graft. Sometimes the graft comes from a donor instead of the patient. Other times—depending on the quality of the patient’s ligament—special sutures and anchors can be used to repair and reinforce the ligament.
First, the surgeon removes any damaged tissue from the elbow. If there is any undamaged ligament left, the surgeon will usually try to incorporate it into the reconstruction to add extra strength.
To attach the graft, the surgeon drills holes in the humerus and ulna, secures it with sutures or screws and then loops the graft through the holes in a figure-eight pattern. The body uses the graft as a scaffold to eventually grow a new ligament.
The elbow will be immobilized immediately after the surgery for one to two weeks. After this time, physical therapy will initially be focused on the surrounding muscles and structures–like the forearm, wrist and biceps–to prevent muscle wasting.
The elbow can then be moved and physical therapy aimed at strengthening the arm and returning range of motion, can begin. Most patients will be fully recovered from the surgery in about four months. Throwing athletes, however, may need nine months or longer to return to their sport.
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