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

Nonsurgical Management

Treatment of symptomatic pitchers with a previous UCL reconstruction can be challenging. Nonsurgical treatment may be an option when patients report a gradual increase in pain without an injury. Patients with an acute injury and rupture are less likely to respond to nonsurgical treatment.

The injured tissue requires time to heal; therefore, pitching should be discontinued for 6 to 12 weeks. Plans for therapy and rehabilitation are key. The focus of nonsurgical treatment should be on addressing factors that may have added stress on the elbow, including scapular dyskinesis, glenohumeral internal rotational deficiency, and poor pitching mechanics. Strength deficits and imbalances in the core lower extremity and scapular stabilizer should be addressed, as well.

Anti-inflammatory medication and a physical therapy regimen of stretching and strengthening should be attempted. Injections of platelet-rich plasma or bone marrow aspirate also are options; however, we recommend against the use of steroid injections for fear of attenuating and weakening the soft tissues. Once rest and therapy have been initiated and the pitcher is pain free at rest, a gradual integrated throwing program can be initiated[19] (Table 1).