Management of Ulnar Collateral Ligament Injuries of the Elbow

Ulnar collateral ligament (UCL) injuries are increasingly prevalent among overhead throwing athletes, with reconstruction rates rising 193% from 2002 to 2011 and an annual 9% increase among adolescents. This review synthesizes current evidence on the anatomy, biomechanics, clinical evaluation, and management of UCL injuries, with a focus on comparative outcomes across nonsurgical and surgical treatment strategies.

Nonsurgical management achieves return to sport in 80-100% of non-throwing athletes, while outcomes in overhead throwers are highly dependent on tear location, with proximal tears yielding superior success rates (89.7%) compared to distal tears (41.2%). Platelet-rich plasma remains controversial. UCL reconstruction achieves 80-97% return to play at 12-14 months; however, return to pre-injury performance is less consistent (67-87%). Primary repair with internal brace augmentation offers comparable return-to-play rates (98%) with a faster recovery timeline (9.2 versus 13.4 months) in appropriately selected patients with acute avulsion injuries. Treatment decisions should be individualized based on injury characteristics, tear location, tissue quality, and patient competitive goals. The proposed treatment algorithm stratifies management by tear location to facilitate evidence-based decision-making and realistic preoperative counseling.