Revision Ulnar Collateral Ligament Reconstruction

Jeremy R. Bruce, MD; Neal S. ElAttrache, MD; James R. Andrews, MD


J Am Acad Orthop Surg. 2018;26(11):377-385. 

In This Article

Abstract and Introduction


Ulnar collateral ligament injuries continue to occur despite efforts to educate pitchers, coaches, and families at the amateur and professional levels about pitch counts, mechanics, and injury prevention. Although the data on the incidence of ulnar collateral ligament reconstructions are inconclusive, an increase in these reconstructions may mean a corresponding increase in the number of reconstruction failures and revision reconstruction surgeries. Less is known about the outcomes of revision ulnar collateral ligament reconstruction; not unexpectedly, early results are not as promising as those observed with primary reconstruction. In response, interest in revision techniques, rehabilitation, and outcomes of revision ulnar collateral ligament reconstruction surgeries has grown.


The throwing athlete's elbow has become a well-studied joint because of the increase in the number of ulnar collateral ligament (UCL) injuries and the multibillion dollar business of Major League Baseball (MLB). Since Frank Jobe performed the original UCL reconstruction on MLB pitcher Tommy John in 1974, many important modifications have improved the outcomes of this procedure,[1,2] including return-to-play rates as high as 80% to 90%.[2,3–5] Therefore, UCL reconstruction has become more popular over the decades, especially among MLB pitchers. An estimated 25% of major league professional pitchers have undergone UCL reconstruction.[6] With increased use of this procedure, the number of revision UCL reconstructions may increase as well.