Elbow Ulnar Collateral Ligament Repair with InternalBrace®

Elbow ulnar collateral reconstruction has provided successful return to throwing sports in high level athletes that sustain elbow UCL injuries. Unfortunately, much like knee ACL injuries, the recovery has traditionally been prolonged, typically one year, and often requiring a slow, gradual return to sport and previous level of frequency/intensity of throwing. This has been the subject of intense, controversial game management decisions for elite professional pitchers in MLB, for instance.

Recently, a new elbow procedure has been developed for some elbow UCL tears: UCL repair with InternalBrace. This procedure, rather than replacing or reconstructing the UCL using either a tendon from elsewhere in the patient’s body or a donor tendon, instead the native UCL is repaired and reinforced by a strong tape-like suture material secure into both the humerus and ulna bones with plastic anchors. The suture tape is coated in collagen to encourage a natural healing response, and the type protects the ligament while it heals, and continues to structurally support the ligament against extreme valgus stresses seen in the elbow during high-velocity throwing, especially baseball pitching.

Because this procedure repairs the existing ligament, and therefore does not require a donor tendon to transform into a ligament (a process called ligamentization), the healing time in early research has been much faster than traditional reconstruction, typically half the time for return to throwing sports (6 months versus 12 months for traditional reconstruction).

Like all surgical procedures, successful outcomes depend largely on appropriate indications. This procedure is most ideal for young throwing athletes (adolescents, 20s) with acute-onset tears (< 3 months) occurring at either the origin or insertion of the ligament (often referred to as an avulsion). Less ideal candidates for the UCL repair with InternalBrace procedure including older throwing athletes (30s, 40s), chronic tears (> 6 months), and midsubstance tears. Each athlete is unique, however, and an in-person consultation is the best way to determine whether an athlete is an appropriate candidate.

Elbow Procedures