Primary repair of ulnar collateral ligament injuries of the elbow in young athletes - A case series of injuries to the proximal and distal ends of the ligament

Background: Little data exist regarding the treatment of young high school and college athletes with medial ulnar collateral ligament insufficiency of the elbow. It would be logical to assume that younger patients would have less damage to the ligament, allowing the possibility of repair. Hypothesis: Many young athletes with injuries to the medial ulnar collateral ligament have proximal or distal injuries that may be amenable to repair, indicating that graft reconstruction may not always be necessary to obtain satisfactory results. Study Design: Case series; Level of evidence, 4 Methods: Sixty patients who had direct repair of the medial ulnar collateral ligament were retrospectively evaluated using the Andrews and Carson elbow score. All patients had symptomatic instability that precluded them from participation in their desired sports, all failed a nonoperative treatment program, and all had comparative stress radiographs, magnetic resonance images, or computerized tomograms with contrast studies that had positive findings for insufficiency of the ligament. Results: The mean age of the 47 male and 13 female patients was 17.2 years. The mean follow-up was 59.2 months. All patients underwent medial ulnar collateral ligament repair by one of the following procedures: suture plication with repair to bone drill holes (n = 9) or suture repair to bone using anchors (n = 51). The mean overall preoperative Andrews-Carson outcome score of 132 improved to 188 postoperatively (P < .0001). Good-to-excellent overall results were obtained in 93% of patients. Fifty-eight of the 60 patients were able to return to sports within 6 months of the surgery at the same or higher level as before the injury. There were 4 failures, 2 early and 2 late (after return to play for 5 and 6 years of unrestricted play, respectively). Three patients sustained a complication of transient postoperative ulnar neuropathy symptoms that resolved spontaneously. Conclusion: Primary repair of proximal and distal injuries of the medial ulnar collateral ligament is a viable alternative in the nonprofessional athlete. Graft reconstructions may not be necessary to obtain favorable outcomes and rapid return to sports in nonprofessional athletes who require surgical intervention for medial elbow instability.