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.
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Frequently Asked Questions about Elbow Ulnar Collateral Ligament Repair with InternalBrace®
- Which is better, Ulnar Collateral Reconstruction or Ulnar Collateral Ligament Repair?
- For a patient with an elbow UCL tear, this is a natural question. Every athlete wants the best surgery, the best recovery, and the best performance when they return to sport. However, in many ways this is the wrong question, or at least, the question requires answers to other questions first. Is the tear acute or chronic? Acute is more often amenable to repair, whereas a chronic tear typically better treated with reconstruction. Is the UCL tear in its midsubstance or near its anatomic origin/insertion? Insertional tears are better indicated for repair, whereas midsubstance tears are a better indication for reconstruction. What is the athlete’s situation? A high school or college junior has no plans to play at the next level, and injures his/her elbow near the end of the season, needing a relatively quick recovery to play senior season. That scenario is a good situation to consider repair, when the timeline is not conducive to the typical year or longer recovery of UCL reconstruction. For an athlete that prefers the option with the longest track record of success, the answer is undoubtedly reconstruction, which has successfully restored elbow stability for decades.
- Do you need an internalbrace for UCL reconstruction?
- In short, no. This question may be mistaking technical details of repair versus reconstruction. The newer repair procedure utilizes internalbrace, which comprises high-strength fibertape suture, to reenforce and protect the ligament while it is healing, and provide additional protection during throwing activities. The internalbrace is the underpinning of the repair procedure. On the other hand, UCL reconstruction surgery typically does not include the addition of an internalbrace. It is considered unnecessary given the ligament has been rebuilt, or reconstructed, with a strong graft. While the merits of suture augmentation to a ligament reconstruction can be debated, certainly it can not be argued that an internalbrace is needed or required in order to achieve a successful outcome.