By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- A new procedure to repair rather than replace the torn ulnar collateral ligament in the elbow is very promising
- This procedure can potentially cut the rehab time and return to play time by more than half
- There are very specific criteria for surgery which must be carefully met, and long term data is still needed
The ulnar collateral ligament in the elbow is a critical stabilizer, and one that gets stressed during the baseball pitch. We’ve seen a substantial increase in tears of the ulnar collateral ligament in all age groups but especially in teenage pitchers. The standard of care for those athletes choosing surgery is a ligament reconstruction commonly known as “The Tommy John” procedure. The traditional surgery has undergone refinements over the years and has a high success rate, but the downside is that return to competitive pitching takes more than a year, often around 16 months (that’s two seasons of sport…). But a new procedure offers the chance to potentially cut the rehab time and return to play time to less than half.
At a recent meeting of the American Orthopaedic Society for Sports Medicine, Dr. Christopher Looze presented research showing the results of a novel surgical technique performed by Dr. Jeff Dugas at the Andrews Institute in Birmingham, Alabama.
In the traditional “Tommy John” surgery the damaged elbow ligament is replaced by a tendon taken from the forearm or hamstring. This tendon is attached by drill holes and absorbable anchors in the bone. The surgery is fairly invasive and requires a substantial amount of healing time, followed by an extensive rehabilitation time.
In the newer procedure performed in very selective instances by Dr. Dugas, the torn elbow ligament is repaired and augmented with a collagen coated tape (an “internal brace”) rather than the more extensive replacement procedure.
The early outcomes are promising. Looze and Dugas followed 66 overhead throwing athletes who underwent UCL repair with internal brace augmentation for at least 1 year and collected data on return to play, time of return to play and level of return to play.
Most of the athletes were high-school aged pitchers. An impressive 96% were able to return to the same level of play. But most impressive by far is that the average time to return to play is about 6 months, with 65% of athletes returning at fewer than 6 months. Cutting return to play from 16 months to 6 months is a phenomenal benefit.
Dr. Dugas pointed out in commentary to the presentation that the results are preliminary (a fairly small number of athletes followed out to about a year), and that there are very strict criteria used to determine whether an athlete is an appropriate candidate. The tissue quality must be excellent and the location of the tear within the ligament is also important. These are factors that will be further refined with additional data.
Without a doubt the best way to keep pitching is to avoid an injury in the first place by following available best recommendations such as PitchSmart. But for those athletes opting for surgery the new ligament repair procedure and internal brace augmentation offers the potential for outstanding results with a much faster return to play timeline. We’re watching this procedure closely.