Elbow range of motion is stable or improves following ulnar collateral ligament repairs and reconstructions

The increasing incidence of ulnar collateral ligament (UCL) injuries in throwing athletes has resulted in a concomitant increase in annual UCL repair and reconstruction procedures. While elbow stiffness remains a small but significant postoperative complication, little data have been published regarding range of motion (ROM) trajectories postoperatively and factors that impact final recovery. This study aimed to determine the trajectory of elbow ROM recovery following UCL repairs and reconstructions and to identify the factors that impact a patient's final motion.

For our analysis, we utilized the Pitch Registry, a multi-institution, prospectively collected registry database of players with UCL injuries hosted by Major League Baseball. A total of 506 patients who underwent UCL repairs or reconstructions from 2019 to 2025 were screened for analysis, and 146 were selected based on 2-year follow-up data and the availability of consistent ROM data at regular postoperative visits. Baseline demographics, patient questionnaires, and measurements of elbow flexion/extension were collected. Intraoperative variations, including repair versus reconstruction (with palmaris versus gracilis autograft), ulnar nerve transposition, and arthroscopic débridement, were documented. At each subsequent postoperative visits, elbow flexion and extension were documented.

On average, patients recovered their preoperative ROM between 2 and four months, with repair and gracilis autograft groups demonstrating significant final improvements in flexion (4.9° and 5.2°, respectively). Preoperative ROM was a strong predictor of final outcomes, with a greater baseline extension deficit predicting more improvement (R² = 0.593) and greater baseline flexion predicting less improvement (R² = 0.428). Ultimately, only 19.2% of patients failed to recover either flexion or extension to within 5° of their baselines. These patients were significantly older than those who recovered (21.6 vs. 19.4 years) and had higher baseline flexion.

Following UCL repairs and reconstructions, elbow ROM is reliably preserved or improved. The recovery follows a predictable trajectory of rapid improvement within the first 2 to four months. Preoperative ROM, patient age, surgical technique, and baseline patient questionnaire scores are predictive of final ROM. These findings are critical for informing surgeon-patient discussions, setting expectations, and optimizing rehabilitation.