What is UCL?
The ulnar collateral ligament (UCL) is located on the inside of the elbow and connects the bone of the upper arm to a bone in the forearm. The UCL is vital to maintaining elbow stability and function. This ligament may be torn as a result of injury or dislocation of the elbow, or damaged by overuse and repetitive movement and stress. If injuries do not heal properly, the elbow may become loose or unstable. Symptoms of a UCL injury include pain on the inside of the elbow, numbness, tingling, and decreased arm and elbow strength. A UCL injury is more common in athletes, especially baseball players, who use their arm constantly in a throwing motion.
Treatment for a UCL injury varies, and initial treatment may include rest, anti-inflammatory medication, and physical therapy. If symptoms persist and do not respond to conservative methods of treatment, surgery to reconstruct or repair the joint, may be necessary. Ulnar collateral ligament reconstruction is a procedure used to repair a torn or damaged UCL ligament. This procedure is commonly referred to as Tommy John surgery, named after the first baseball player to undergo the procedure.
The Ulnar Collateral Ligament Reconstruction Procedure
This procedure is performed through an incision that is made on the inside of the elbow joint. During the ulnar collateral ligament reconstruction procedure, the surgeon replaces the torn ligament with a tissue graft. In most cases of UCL injury, the ligament can be reconstructed using one of the patient's own tendons, commonly taken from the forearm, hamstring, foot, or knee. Sutures are used to secure the tendon graft in position. When the procedure has been completed, the incision is sutured closed and the elbow is bandaged and placed in a splint.
What Are the Risks of Ulnar Collateral Ligament Reconstruction?
As with any surgical procedure, there are risks associated with ulnar collateral ligament reconstruction, which may include:
- Reaction to anesthesia
- Nerve or blood vessel damage
Some patients may continue to experience chronic pain and instability of the elbow, even after surgery.
What is the Success Rate of UCL Reconstruction?
Multiple studies set the success rate of UCL reconstruction at 85 to 90%. In some studies, patients' final follow-up occurred two years after their treatment. At that time, the vast majority of them had returned to their previous level of physical activity, even playing sports.
Is UCL Reconstruction Painful?
The surgical repair of the ulnar collateral ligament is performed under general anesthesia. While under anesthesia, you cannot feel pain. There is very little chance that you will remember the time around your surgical procedure, as well, due to the effects of the sedative medications you receive. When you wake up from surgery, you may feel mild to moderate discomfort in the arm. You will need to take your pain medication as prescribed to effectively manage the soreness and tenderness that is common after surgery.
For How Long Will UCL Reconstruction Hinder Daily Activities?
You can expect to be able to go back to work or school one to two weeks after your UCL reconstruction. Until that time, you will likely have to wear a splint that immobilizes the elbow. Some sort of brace may be worn for approximately four weeks, which might limit the activities that you can do. Through physical therapy rehabilitation, you can expect to regain full range of motion in the elbow by six-weeks post-op. At that time, you may increase your activities. Athletes may need several months to regain the extent of motion and strength needed to return to their sport.
How Many Visits Are Needed to Complete the Procedure?
Your doctor at Orthopedic Associates of Long Island can determine the best treatment for you at your first consultation visit. You may require imaging tests or lab tests before your surgery can be scheduled. In general, no more than a few visits should be necessary before you can have your UCL reconstruction. After your procedure, you may have one or more follow-up visits to monitor your recovery and rehabilitation.
After Reconstruction, What Physical Activities Will Help Maintain My UCL?
After your UCL reconstruction, you will enter a physical therapy program that will focus on restoring strength and range of motion to the elbow. To achieve optimal improvements during your recovery, it is necessary to perform the exercises demonstrated by your physical therapist as often as they advise. Physical therapy does not happen only in the therapy facility, you also need to perform prescribed range-of-motion exercises and strengthening exercises at home. Until you are fully cleared by your physical therapist and doctor, you should not engage in any physical activities without talking to them first. Our primary objective is to allow the graft to heal properly so there is little risk of limitations in the future.
Recovery and Results
The elbow is immobilized for one to two weeks after surgery. After that time, a physical therapy program will help the individual to regain strength, flexibility and range of motion. Full recovery from an ulnar collateral ligament reconstruction may take from 6 to 9 months.