Operative strategies for ulnar collateral ligament insufficiency

Abstract

The first described medial ulnar collateral ligament (UCL) reconstruction, popularly referred to as Tommy John surgery, was performed in 1974 by Dr. Frank Jobe. Since the first description, a number of technique and rehabilitation modifications have been described, with notable improvement in outcomes for throwing athletes. As the rate of UCL reconstruction surgery continues to increase across the country, particularly in adolescent baseball players, there has been an increased focus on efforts to reduce UCL injury in this population, including pitch count limits and scheduled time off from throwing for young athletes. When surgery is required, modern techniques utilizing a flexor-pronator splitting approach have provided consistent results, with return to sport rates of 90 % frequently reported, while avoiding ulnar nerve symptoms that plagued early reconstructions. Despite the increased incidence of UCL reconstruction, the rate of revision UCL reconstruction surgery has decreased, likely secondary to improved surgical techniques and rehabilitation protocols. In addition to providing a review of UCL reconstruction outcomes, we provide a description of the docking technique, the authors preferred method of UCL reconstruction.