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Return to sport after ulnar collateral ligament repair and reconstruction
Mitchell S Kirkham1, Bejan A Alvandi2, Kyle B Christy2
1Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; School of Medicine, University of Utah, Salt Lake City, UT, USA.
Journal of Shoulder and Elbow Surgery
|May 30, 2026
Summary
Suture-augmented ulnar collateral ligament (UCL) repair and UCL reconstruction both offer high return to play rates for overhead athletes. Repair allows a quicker return to sport and fewer ulnar nerve issues, but has a higher overall complication rate.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanics
Background:
- Rising incidence of elbow ulnar collateral ligament (UCL) injuries in young overhead athletes necessitates optimal treatment identification.
- Ulnar collateral ligament reconstruction is the traditional standard, while suture-augmented UCL repair is gaining popularity for avulsion tears.
- Evaluating complications, outcomes, and return to sport (RTS) is crucial for guiding treatment decisions.
Purpose of the Study:
- To compare clinical outcomes, complication rates, and return to sport (RTS) between UCL repair and reconstruction in overhead athletes.
- To test the hypothesis that UCL repair would yield similar RTS rates as reconstruction, but with faster recovery and fewer complications.
Main Methods:
- Retrospective review of 73 consecutive patients undergoing UCL repair or reconstruction by a single surgeon (March 2017-March 2023).
- Data collected included demographics, injury history, physical exam findings, imaging, and intraoperative details.
- Two-year follow-up assessed patient satisfaction, reoperations, post-operative complications, ulnar nerve function, and time to return to throwing and full play.
Main Results:
- Patients returned to throwing programs at 3.4 months (repair) vs. 4.3 months (reconstruction).
- Return to full play occurred at 8.3 months (repair) vs. 10.0 months (reconstruction).
- 97% of patients in both groups achieved return to play, with high rates of returning to pre-injury level and position.
Conclusions:
- Both UCL repair and reconstruction are effective for UCL injuries in overhead athletes, demonstrating high return to play rates.
- UCL repair showed a faster return to throwing (0.9 months) and full play (1.7 months) with lower rates of ulnar neuritis.
- Reconstruction had a lower overall complication rate (3%) compared to repair (10%), though findings are associative due to differing procedural indications.
