Ulnar collateral ligament reconstruction in elite throwing athletes: minimum 2-year follow-up (SS-37)

Objective: Ulnar collateral ligament (UCL) injuries may result in disabling valgus instability in throwing athletes. We evaluated the “docking technique” for UCL reconstruction, and describe a modification to the technique. Methods: UCL surgery was indicated in 19 high-level baseball players (11 professional, 8 collegiate) with medial elbow pain preventing effective throwing, medial pain with valgus stress, and MR arthrogram. Mean age was 21.8 (17.9–26.2). 1 had previous UCL reconstruction. 1 had previous arthroscopic elbow debridement. Reconstruction was performed using a muscle-splitting approach and the docking technique with palmaris or semi-tendinosus graft. Initially, a 2-strand construct was used; but during the study period we developed and began using a 3-stand construct using a doubled anterior bundle and a single posterior bundle. The ulnar nerve was not routinely transposed unless there were preoperative ulnar nerve symptoms (2 patients). 2 had osteophyte debridement. 1 had removal of a loose body. Results: Patients were followed for an average of 37 months, with a minimum 2 year follow-up. 18 returned to previous or higher level of participation. Three were collegiate infielders/occasional pitchers who did not wish to return to pitching but continued to play other positions. They were clinically and functionally asymptomatic. One player was lost to follow-up, and could not be identified on a professional roster. The average time to return to play was 15 months (6.5–27.8 months). Using the Timmerman-Andrews 100-point subjective scoring system, the average preoperative score was 81.5 (65–85); average postoperative score was 97.7 (80–100). Using the Conway-Jobe scoring system, 15 were excellent, 3 good. 1 patient underwent subsequent ulnar nerve transposition, and returned to previous level of professional play. Conclusions: UCL reconstruction with the docking technique can reliably return athletes to a high level of participation. This technique allows ease of graft handling and tensioning. The modification of a doubled anterior bundle increases the amount of collagenous tissue in a critical area, and may allow more accelerated rehabilitation.