Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction

Elbow injuries in overhead athletes, particularly ulnar collateral ligament (UCL) injuries to baseball pitchers, continue to increase in number. The reasons for these injuries are multifactorial but typically result from a combination of severe and repetitive valgus elbow stress from pitching large volumes and throwing at peak velocities. These factors and the severity of medial elbow injuries to the UCL complex make it critical to employ a proper criteria-based rehabilitation program in combination with a well-structured set of return-to-play criteria. Together, the rehabilitation process and return-to-play program provide a set of guidelines that help ensure a safe and effective process to aid in returning a throwing athlete back to unrestricted competition as efficiently as possible. This article provides the reader with a 4-phased, criteria-based rehabilitation program for the athlete following UCL reconstruction and a structured set of return-to-play guidelines. The return-to-play progression is a 3-step process that assists in advancing an athlete back to unrestricted competition via a performance, practice, and play sequence. This program uses specific criteria and activities to progress a throwing athlete from high-level performance training, to controlled practice participation and then finally back to play. The program uses not only specific steps but also a combination of testing parameters both subjective and objective to guide the return through the entire rehabilitation process from UCL reconstruction surgery back to unrestricted symptom-free throwing.