Medial Collateral Injury in the Young, Nonprofessional Athlete: Surgical Repair

Injuries to the medial ulnar collateral ligament (UCL) have traditionally been treated with reconstructive methods aimed at recreating medial elbow stability. At our practice in Birmingham, Alabama, thousands of overhead athletes have been treated with UCL reconstruction regardless of the injury severity or the patient being treated. Reconstruction techniques include autograft harvest and implantation at the native UCL origin and insertion. Rehabilitation, graft maturation, and return to play can take anywhere from 12-18 months on average. We have experienced excellent long-term outcomes with 84% return to play at the same or higher level at an average of 11.4 months. of UCL injuries has reached near epidemic proportions with a fiercely competitive youth baseball culture in America. The number of UCL reconstructions at our institution alone nearly tripled at the youth and high school level between 1998 and 2008. The young, nonprofessional athletic population accounts for a significant number of UCL injuries being managed nation wide each year, and until recently, with a gold standard ligament reconstruction approach. With advancements in suture anchor technology we began to ask whether the severity of injury or patient characteristics, such as end-avulsions in the young athlete, called for alternative fixation methods. This led us to create a novel repair and augmentation construct that involved suture fixation of the avulsed native UCL to bone followed by reinforcement of the ligament along its entirety.is our recommendation that patients identified as candidates for UCL repair have intraoperative confirmation of ligament end-avulsions or partial thickness tears with minimal midsubstance damage. This article highlights our criteria for patient selection and reviews our newly described technique of repair.