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


The volume of UCL reconstructions performed in the United States has grown exponentially. Petty et al[7] found that the number of reconstructions performed at the American Sports Medicine Institute (ASMI) increased from 85 between 1988 and 1994 to 609 between 1995 and 2003. Cain et al[3] reported similar findings in a study of 1,281 UCL reconstructions and repairs performed by the senior author (J.R.A.) from 1988 through 2006; the number of reconstructions increased from approximately 500 between 1999 and 2002 to 800 between 2003 and 2006.

Recent data indicate that an average of 15 to 20 MLB pitchers undergo UCL reconstruction annually.[8] However, that number spiked to 33 reconstructions in 2012.[8] A survey conducted in 2012 found that 25% of major league pitchers and 15% of minor league pitchers had undergone UCL reconstruction at some point in their career.[6]

With increasing numbers of UCL reconstructions being performed, a corresponding increase in revision reconstructions might be expected. However, the data are inconclusive. Some initial data demonstrated that revision reconstruction rates were as low as 1% to 4%.[3,9–11] For example, in the largest series of UCL reconstructions to date involving >700 athletes, only 1% required a revision UCL reconstruction.[3] In contrast, a 2015 study involving 271 professional pitchers found that 40 (15%) had undergone UCL revision surgery, with 3 patients requiring a second revision procedure.[8] Although the rates of revision surgery are increasing, this remains a rare procedure, and proper diagnosis, surgical technique, and rehabilitation are paramount.