Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes.
BACKGROUND
Ulnar collateral ligament (UCL) injuries lead to pain and loss of performance in the thrower's elbow. Ulnar collateral ligament reconstruction (UCLR) is a reliable treatment option for the symptomatic, deficient UCL. Injury to the UCL usually occurs because of chronic accumulation of microtrauma, although acute ruptures occur and an acute-on-chronic presentation is also common.


METHODS
Computerized databases, references from pertinent articles, and research institutions were searched for all studies using the search terms ulnar collateral ligament from 1970 until 2015.


METHODS
Clinical review.


METHODS
Level 5.


RESULTS
All studies reporting outcomes for UCLR are level 4. Most modern fixation methodologies appear to be biomechanically and clinically equivalent. Viable graft choices include ipsilateral palmaris longus tendon autograft, gracilis or semitendinosus autograft, and allograft. Clinical studies report excellent outcomes of UCLR for both recreational and elite level athletes with regard to return to sport and postoperative performance. Complications, although rare, include graft rerupture or attenuation, ulnar nerve symptoms, stiffness, pain, and/or weakness leading to decreased performance.


CONCLUSIONS
Injuries to the UCL have become commonplace among pitchers. Nonoperative treatment should be attempted, but the limited studies have not shown promising results. Operative treatment can be performed with several techniques, with retrospective studies showing promising results. Complications include ulnar neuropathy as well as failure to return to sport. Detailed preoperative planning, meticulous surgical technique, and a comprehensive rehabilitation program are essential components to achieving a satisfactory result.
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois berickso.24@gmail.com.
Brandon J
BJ
Erickson
Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas Weill Cornell College of Medicine, New York, New York.
Joshua D
JD
Harris
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois.
Peter N
PN
Chalmers
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois.
Bernard R
BR
Bach
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois.
Nikhil N
NN
Verma
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois.
Charles A
CA
Bush-Joseph
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois.
Anthony A
AA
Romeo
D018771:Arthralgia / Q000209:etiology; D001265:Athletic Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D017885:Collateral Ligaments / Q000033:anatomy & histology / Q000293:injuries* / Q000601:surgery*; D004551:Elbow Joint / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D000092464:Elbow Injuries
Tommy John; biomechanics; elbow; instability; pitcher; surgical management; throwing athlete; ulnar collateral ligament reconstruction