Ulnar Collateral Ligament Repair A. Ryves Moore, MD a,b , Glenn S. Fleisig, PhD b , Jeffrey R. Dugas, MD a, * KEYWORDS  UCL  UCL repair  UCL reconstruction  Internal brace  UCL partial tear  UCL avulsion KEY POINTS  Ulnar collateral ligament (UCL) injuries are increasing in adolescent overhead athletes.  There is a wide spectrum of UCL injuries ranging from partial tears and end avulsions to chronic attritional tears.  UCL reconstruction has been the gold standard for treating all varieties of UCL injuries since Dr Frank Jobe performed the first UCL reconstruction in 1974 on Tommy John.  Newer techniques of UCL reconstruction for partial tears or end avulsions have shown promising results with accelerated rehabilitation and earlier return to play compared with conventional UCL reconstruction. INTRODUCTION The anterior bundle of the ulnar collateral liga- ment (UCL) is the primary restraint to valgus force at the elbow and experiences tremendous stress during the arm-cocking and arm- acceleration phases of throwing. 1–4 With the increasing emphasis on sports specialization, year-round play, and ball velocity, UCL injuries have become increasingly common, most notably in baseball pitchers and other overhead athletes 5 (Fig. 1). Typically, rest from throwing activities coupled with rehabilitation is the first line of treatment. 6,7 If the athlete is unable to re- turn to throwing after conservative measures, then surgery is recommended. 8–11 Traditionally, UCL reconstruction as first described by Dr Frank Jobe in 1974 is consid- ered the gold standard for the treatment of UCL injuries in overhead athletes. 8–10,12 Since UCL reconstruction was first described more than 40 years ago, the procedure has undergone technical improvements and has demonstrated better clinical results with regards to return to play and relatively low complications. 13–19 Despite this success, there are several shortcom- ings with UCL reconstruction. First, time to re- turn to play is long (typically 12–18 months for baseball pitchers), meaning that athletes will routinely lose at least 1 season. 19,20 Second, given that these injuries are diagnosed in younger patients earlier in the injury process, it has been recognized that there is a wide spec- trum of disease ranging from low-grade partial tears to chronic complete tears with tissue defi- ciency. This realization begs the question, is reconstruction necessary for the entire spectrum of UCL injuries, or is repair a viable option for some of these patients? Historically, attempts at primary repair of the UCL demonstrated poor outcomes among pro- fessional pitchers, with 0% to 63% rates of re- turn to play at the same level or higher. 8–11,21 However, recent reports of direct suture repair of an injured UCL have shown successful out- comes in young athletes with proximal or distal tears. 21,22 Disclosures: J.R. Dugas is a paid consultant for Arthrex, Topical Gear, and Theralase; receives royalties from Topical Gear and Theralase; and has stock/stock options in Topical Gear and Theralase. No author or related institution has received any financial benefit or funding for this article. a Andrews Sports Medicine and Orthopaedic Center, 805 St. Vincent’s Drive, Suite 100, Birmingham, AL 35205, USA; b American Sports Medicine Institute, 833 St. Vincent’s Drive, Suite 205, Birmingham, AL, USA * Corresponding author. E-mail address: jeff.dugas@andrewssm.com Orthop Clin N Am 50 (2019) 383–389 https://doi.org/10.1016/j.ocl.2019.03.005 0030-5898/19/ª 2019 Elsevier Inc. All rights reserved.