Related Experiment Video
Updated: Jul 7, 2026
Harvesting of Peroneus Longus Tendon Autograft
Published on: September 2, 2025
Clinical Outcomes After Ulnar Collateral Ligament Reconstruction With Palmaris Longus Versus Gracilis Autograft in
Michael C Ciccotti1, Brooks Martino1, Frank Cautela1
1Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.
Background:
Ulnar collateral ligament (UCL) reconstruction (UCLR) is a common procedure for overhead athletes, particularly baseball players sustaining partial or full UCL tears. Palmaris longus (PL) and gracilis (GR) autografts are the most frequently used graft sources, yet limited data compare clinical outcomes in baseball athletes.
Purpose:
To compare patient-reported outcomes after UCLR with PL versus GR autografts in baseball players.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Patients who underwent isolated UCLR with either PL or GR autograft and a minimum of 2 years of follow-up were identified. All reconstructions were performed using the Modified Jobe or Docking techniques, followed by a standardized rehabilitation protocol. Demographic characteristics, playing level, preoperative elbow function, and operative details were obtained. Included patients completed patient-reported outcomes (PROs), including the Kerlan-Jobe Orthopedic Clinic Shoulder & Elbow score (KJOC), the Timmerman and Andrews elbow score, the Conway-Jobe scale, and custom patient satisfaction and return-to-play (RTP) questionnaires.
Results:
A total of 71 athletes (50 GR, 21 PL) met the inclusion criteria. Groups did not differ in age, body mass index, level or position of play, preoperative range of motion, valgus/varus stability, magnetic resonance imaging tear thickness, ultrasound gapping, or preoperative KJOC scores. Surgical technique, use of internal brace, nerve management, and intra- or postoperative complications were similar between groups (P≥ .421). At ≥2-year follow-up, PROs were comparable: KJOC (GR: 77.6 ± 22.4 vs PL: 75 ± 22.6; P = .584), Timmerman-Andrews (GR: 89.9 ± 13.2 vs PL: 87.2 ± 8.16; P = .093). RTP outcomes by Conway-Jobe scale were similar (P = .867). Time to RTP did not differ between groups (GR: 12.5 ± 2.7 months vs PL: 10.8 ± 3.8 months; P = .170). The only postoperative difference was greater elbow flexion in the PL group (148° vs 144°; P < .001). Extension, supination, and pronation did not differ (P≥ .133).
Conclusion:
PL and GR autografts demonstrate equivalent clinical and RTP outcomes after UCLR in baseball players.