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UCL Repair Offers Shortened Recovery Period to Athletes

Advance With MUSC Health
December 09, 2021
Provider examining patient elbow

Ulnar collateral ligament repair, an increasingly popular alternative to UCL reconstruction, gets throwing athletes off the injured list and back on the playing field safely and faster than traditional surgical treatments.

Used frequently on baseball pitchers, UCL repair reduces post-surgery pain and recovery time by half, says Dr. Josef K. Eichinger, an orthopaedist and sports medicine physician at MUSC Health, singled out in U.S. News & World Report as one of the nation’s top performing hospitals and the No. 1 hospital in South Carolina. He is part of a nationally recognized team that performs the procedure on athletes from middle-school age up to professional players.

“Our patients can get back to the playing field faster and experience a full recovery in a shorter timeframe than previously believed,” says Dr. Eichinger, a MUSC Health sports medicine team physician for the Charleston RiverDogs, an affiliate of the New York Yankees.

A UCL injury can be mild, with inflammation on the inside of the elbow, to severe, causing pain and limiting a pitcher’s motion, mobility and throwing velocity.

In the 1970s, surgeons began treating severe UCL tears with ligament reconstruction by taking a tendon from the forearm and using it to create a new UCL. The surgery is named after Tommy John, a former LA Dodgers and NY Yankees pitcher who underwent the first surgery performed by Dr. Frank Jobe, who pioneered the procedure. While Tommy John surgery has been very successful at getting throwing athletes back to competition, it involves a lengthy recovery process that takes about a year to recover and return to play.

“In contrast, the UCL repair is less invasive and reduces recovery by six months, and that’s crucial because a year off the field can dim recruitment prospects and derail a career,” Dr. Eichinger says.

In a repair, the UCL is reinforced by a strong, tape-like suture that is coated in collagen and locked into the humerus and ulna bones with plastic anchors. The collagen coating aids the healing process. The tape protects the ligament while it heals and continues to brace it against the stress on the elbow associated with high-velocity throwing, especially baseball pitching.

The UCL repair technique is particularly advantageous for younger athletes. The growth plates do not have to be violated, which is a key benefit because young athletes are still growing. Moreover, the quality of the tissue is usually stronger in younger athletes because they have not experienced repeated strains and injury, he says.

“We’re excited about the possibility, especially in younger athletes from high school through college age,” Dr. Eichinger says. “We see repair as a very attractive alternative to reconstruction.”

Still, a physician must choose wisely, he says, noting that communication is a key part of the treatment puzzle. “There are some nuances, and the clinical exam is just the first piece. It’s important to talk with parents, coaches and players to figure out how best to get them back playing, and there’s not a fixed formula. You have to individualize the care, and that is done by getting to know the players’ goals and where they are in their career.”

Dr. Eichinger also performs UCL repair on other sports athletes. Recently, he did a UCL repair on a javelin thrower, a female gymnast and a female football player.

He’s concerned over the continuing uptick in overuse injuries in young athletes.

“Kids are starting to specialize in a sport at a younger age, and when they play one sport throughout the year, they can damage their ligaments and muscles,” he says.

Even though Major League Baseball and the USA Baseball Initiative have pitch-count guidelines for youth, those guidelines are not always followed, according to a research study he conducted and published early this year.

“We found that a significant number of patients were not following the pitch- count guidelines, and some families are still unaware of the pitch count guidelines,” he says. “My colleagues and I have given seminars to coaches and leagues to stress the importance of making sure these pitch counts are being used. Too much of one thing is not good. We recommend that young athletes do multiple sports and take time off from throwing completely for a period of at least three consecutive months every year.”

And for athletes who do suffer an elbow injury, MUSC’s experienced orthopaedics team provides comprehensive treatment and care. ‘’Treating elbows is a niche field, and we see a lot of patients with problems and injuries, especially with throwing athletes. An elbow injury is such a career threatening injury, and if a surgeon doesn’t do it all the time, it can be even more difficult to achieve a good outcome.”  

Dr. Eichinger treats shoulder and elbow injuries and conditions, olecranon fractures, OCD lesions, impingement, degenerative bone conditions and rotator cuff injuries. He performs arthroscopic and open surgery and can be contacted at 843-876-0111 for an appointment or referral.

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Keywords: Orthopaedics, Sports Medicine, For Providers