Modern Surgical Management of Elbow UCL Tears

Live from the Arthrex Team Physician Controversies

🎧 Episode Summary

In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with two leaders in sports medicine—Dr. Neal ElAttrache and Dr. Jeffrey Dugas—to discuss the modern management of ulnar collateral ligament (UCL) injuries in throwing athletes.

Highlights

Changing UCL Injury Landscape

Increasing incidence of UCL injuries and surgeries across all levels of play
Notable rise in adolescent and collegiate pitchers
Contributing factors include year-round play and high pitch velocity

Nonoperative Management & Role of PRP

Nonoperative treatment remains appropriate for select partial tears
Success varies based on tear grade and location
PRP discussed as an adjunct to rehab

Indications for Surgery

Complete tears—especially in competitive throwers—often require surgical intervention
Tear characteristics (location, tissue quality, chronicity) are critical in decision-making

UCL Repair with Internal Brace

Increasingly utilized in appropriately selected patients
Ideal candidates:
- Acute injuries
- Proximal or distal avulsion tears
- Good tissue quality
Advantages:
- High return-to-play (~90%+)
- Accelerated recovery timelines (often several months faster)

UCL Reconstruction (Tommy John Surgery)

Remains the gold standard for:
- Chronic degeneration
- Midsubstance tears
- Revision cases
Techniques have evolved over time:
- Docking technique
- Figure-of-eight
- Newer fixation methods (e.g., cortical button techniques)
Autograft (commonly palmaris longus) remains preferred in elite throwers

Internal Brace Technology

Provides added stability and resistance to valgus stress
Supports early rehabilitation while protecting healing tissue
Increasing use in both repair and, selectively, reconstruction

Key Takeaways

UCL injuries are increasing, particularly in younger athletes
Treatment decisions are increasingly personalized based on tear type and athlete profile
UCL repair with Internal Brace is shifting the paradigm for select patients
Reconstruction remains essential for more complex or chronic injuries

Featured Guests

Dr. Neal ElAttrache – Kerlan-Jobe Orthopaedic Clinic, Head Team Physician for the LA Dodgers & LA Rams
Dr. Jeffrey Dugas – Andrews Sports Medicine & Orthopaedic Center, leading expert in UCL repair and reconstruction

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