Since Dr. Frank Jobe’s initial description of the UCL reconstruction in 1974, it has been the gold standard for treatment of medial sided elbow pain and laxity in the throwing athlete.8,9 Reconstruction techniques have evolved over time with varied applications including docking, Jobe, and modified-Jobe techniques.10–12 Early comparisons of repair versus reconstruction revealed poor outcomes, with less than 30% of repairs returning to the same or higher level of play, especially in a subset of Major League Baseball (MLB) overhead athletes.13,14 Although return to play rates are high with UCL reconstruction, between 85 -90%, the rehabilitation process which ranges between 12-18 months for pitchers is longer than desired.15
Newer technology and greater experience performing direct repairs of the UCL have demonstrated return to play outcomes greater than 95%.16,17 Dugas et. al published two outcome studies first establishing the non-inferiority of UCL repair with internal brace to the modified Jobe reconstruction and then reporting outcomes and return to play to the same or higher level in greater than 90% of patients, 92% of which returned to competition in a 6-7 month time frame.18,19
Although the potential for shorter rehabilitation and quicker return to play are attractive advantages of UCL repair with internal brace when compared with a reconstruction, patient selection is crucial for success. There has been a trend toward an increasing number of adolescent and youth sport participants with UCL injury.16,17 These younger athletes typically have end-avulsions of the UCL or partial tears of the ligament in otherwise healthy ligament tissue. These types of injuries lend themselves well to repair with internal brace. The UCL repair cannot augment a preexisting tissue deficiency. Patients with chronic UCL insufficiency or adaptive changes such as ossification of the ligament are not repair candidates.
