APEX Elbow Mastering Surgical Techniques for Clinical Success-UCL Instability, Reconstruction versus Repair

Video Transcription

Video Summary

Glenn Ross, an orthopedic surgeon from Boston, reviews the evolution of ulnar collateral ligament (UCL) treatment in throwing athletes and leads a faculty discussion on diagnosis, imaging, nonoperative care, and operative technique—especially the shift from reconstruction to repair. He emphasizes that UCL injuries have become far more common, driven by factors like high velocity, year-round play, repetitive throwing (including catching), mechanics, and kinetic-chain deficits. He also highlights problematic public perception: many athletes and parents believe UCL surgery improves performance or is appropriate without true injury.<br /><br />Ross stresses that history and exam are paramount, including careful assessment of the ulnar nerve (usually not a major issue) and use of tests like the moving valgus stress test, while evaluating the entire kinetic chain. Imaging typically includes X-rays and MRI; most panelists prefer non-contrast MRI, though some still use contrast to avoid missing subtle avulsions.<br /><br />Nonoperative management—rest, rehab, and sometimes PRP—is recommended initially, though PRP’s benefit remains unproven and practices vary.<br /><br />Surgically, classic Jobe reconstruction is largely abandoned in primary cases, with docking techniques long dominant. The main focus is modern UCL repair (often with internal bracing), revived by Dugas and others, offering smaller incisions and faster return (often 6–8 months). Ross now performs ~95% repairs, reserving reconstruction for poor tissue quality, gaps, or revisions, and he outlines key technical points such as patient selection (clear proximal/distal avulsion), careful nerve handling, and avoiding overtensioning.

Asset Caption

Moderator: Glen Ross, M.D.

Keywords

ulnar collateral ligament (UCL) injury

throwing athletes and baseball pitchers

UCL repair with internal brace

UCL reconstruction and docking technique

diagnosis and imaging (moving valgus stress test, MRI)

nonoperative management and PRP therapy

kinetic chain deficits and overuse risk factors