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Autograft UCL Tear Surgery

at Cedars-Sinai Marina del Rey Hospital

For over 50 years, our hospital has been providing quality treatment for orthopedic problems, including surgery for ulnar collateral ligament tear. Our medical professionals use state-of-the-art technology to thoroughly assess the overall health of the patient before they undergo the procedure, which is essential in preventing serious postoperative complications.

The surgery you need to undergo for ulnar collateral ligament tear will be performed by using a minimally invasive approach if possible so as to minimize the risks of complications and for you to experience a significantly faster recovery. If your ulnar collateral ligament has been torn during strenuous activity such as playing sports, our hospital is the ideal place where you can receive the treatment you need.

Ulnar collateral ligament tear is a kind of injury to one of the ligaments on the inner side of the elbow. These ligaments connect the inside of the upper arm to the inside of the forearm, which helps stabilize and support the arm. The injury usually occurs as a result of repeated stress from overhead movement, being very common in sports that involve overhead arm use or throwing, such as baseball. Pain on the inner side of the elbow is the primary symptom of ulnar collateral ligament tear.

To repair your torn ulnar collateral ligament, reconstructive surgery will be performed. The primary aims of the surgery are the following:

  • to reduce or eliminate pain
  • to stabilize your elbow
  • to restore your range of motion
  • to regain your elbow stability

This surgery is also known as Tommy John surgery, as the first surgical procedure of this kind was performed by Frank Jobe, M.D. on the baseball pitcher with this name in 1974. During autograft ulnar collateral ligament tear surgery, the torn ligament inside the elbow will be replaced by a tendon harvested from another part of the body, hence the term “autograft”. The graft is generally harvested from one of the following tendons:

  • palmaris longus tendon from the forearm
  • hamstring tendon
  • big toe extensor tendon

Because the ulnar collateral ligament has a reduced blood supply, surgery is generally required to reconstruct it by using a graft from the body of the patient. The graft is obtained by the surgeon through multiple small incisions, and collecting it does not affect the function of that part of the body. After the graft is taken from your body, it will be placed through tiny bone tunnels in the area of the torn ulnar collateral ligament so as to restore the normal anatomy of your elbow.

If adjacent nerves are damaged, the scar tissues around them will be removed during surgery. Similarly, if nearby muscles and ligaments are injured, they will also be repaired during the procedure. The surgical procedure begins with a 3 to 4-inch incision on the inside of your elbow joint. Subsequently, the surgeon prepares the graft taken from your body and replaces your torn ulnar collateral ligament with it. To ensure the graft remains in place, the surgeon will drill holes in the bones that are connected by the ulnar collateral ligament, namely the upper arm bone and the lower arm bone.

When the surgery is completed, your incision will be closed up with several stitches, and your elbow will be covered in a large bandage. Surgery for the repair of a torn ulnar collateral ligament usually takes approximately one hour and a half. In the majority of cases, it is outpatient, which means that you will be allowed to return home the same day after having spent just a few hours in the hospital.

The main benefits of the repair surgery for a torn ulnar collateral ligament are pain relief and the restoration of proper elbow function, as the new ligament will be considerably stronger and healthier. This procedure has a rate of success of 80% to 90%, and a lot of pitchers are able to return to the mound shortly after they undergo surgery. However, some will have to rest for several months to a year before they can resume their athletic activity, depending on how severe their injury was.

Other notable benefits of autograft ulnar collateral ligament tear surgery are the following:

  • the disappearance of numbness in your hand
  • the renewed ability to move your arm and throw with it
  • the alleviation of swelling on the inside part of your elbow and forearm
  • no more tenderness along the inside of your elbow
  • regaining the ability to straighten your elbow
  • the restoration of the ulnar collateral ligament to proper working
  • the absence of elbow pain

According to a study conducted on 179 Major League Baseball pitchers with ulnar collateral ligament tears who had repair surgery, 148 of them were able to return to playing in the Major League once again. In other words, 83% had benefited from the surgery and had their elbow function restored. Furthermore, 174 of these pitchers could resume playing in both major and minor leagues combined.

Recovery

After undergoing autograft repair for ulnar collateral ligament tear, you may have to wear a splint for 7 to 10 days to immobilize your elbow, and you will have some restrictions concerning how to use your arm as it is healing for several months. You may have to do physical therapy to speed up your recovery after the surgery and to restore the range of motion in your elbow for a few months to a year, particularly if you play sports and even more so if you play sports for a living.

The entire recovery period for ulnar collateral ligament tear is one year, as it takes a while for your elbow components to heal and fuse together. In serious cases, athletes have to wait 2 years until they can return to their usual activity, depending on the degree of the damage the injury to their ulnar collateral ligament has caused. On the bright side, cases that do not involve a very serious injury will need less rehabilitation, and those people will be allowed to resume their activity sooner.

This is how the recovery process unfolds for sports players:

  • for the first 4 months, they are advised to avoid any activity that could overstress the graft
  • after 5 months, they can toss a ball without a wind-up motion
  • after 6 months, athletes may begin using easy wind-up when throwing
  • after 7 months, baseball pitchers can return to the mound
  • after 9 months, pitchers may partake in competitions if they are pain-free and have a normal range of motion and strength in their elbow

Risks

While repair surgery for a torn ulnar collateral ligament is usually straightforward and safe, like any other surgical procedure, it implies certain risks. The following are the most commonly associated risks when it comes to this surgery:

  • infection
  • damage to the nerves and blood vessels
  • the need for a second surgery
  • pain at the graft harvest site
  • itchiness or numbness at the graft harvest site
  • weakness and numbness in the arm
  • elbow stiffness
  • swelling around the elbow joint

Complications

The complication rate for autograft ulnar collateral ligament tear repair surgery ranges between 9% to 40%. Naturally, people with mild to moderate injuries will be less likely to experience complications after the surgery, whereas individuals whose damage to the ligament is severe may face serious postoperative complications. Some of the complications of the Tommy John surgery are the following:

  • complications due to general anesthesia
  • the graft stretching or rupturing
  • the irritation of the ulnar nerve

Approximately 26% of people who undergo repair surgery for ulnar collateral ligament tear experience ulnar neuropathy, which causes numbness and tingling in the arm. Elbow stiffness occurs in up to 13% of patients following the procedure, and it may or may not go away. Luckily, the need for a second surgery makes up only 2% of the complications of this procedure.