The first throws toward innovation — UCL repair with internal brace construction developing as option for select patients

Orthopedic Sports Medicine

For decades, athletes had only one option if they tore their ulnar collateral ligament; reconstructive surgery, better known as Tommy John surgery.

However, another option is now emerging as a viable alternative: UCL repair with internal brace construction.

Former St. Louis Cardinals reliever Seth Maness is attempting to become the first pitcher to return to the pros after undergoing UCL repair with internal brace construction. George Paletta, MD, of the Orthopedic Center of St. Louis performed Mr. Maness' procedure.

The procedure is still in the pioneering phase and designed for partial tears only; It consists of repairing the existing ligament and buttressing it at the bone. There has to be enough healthy tissue in an elbow to support the repair, and for pitchers with decades of pitching experience and shredded elbow tissues, Tommy John surgery will remain the only surgical option.

UCL repair has been around for decades appearing in the same paper published in the Journal of Bone & Joint Surgery by Frank Jobe, MD, which popularized Tommy John surgery. It has only recently reemerged in the sports medicine world, according to Jeffrey Dugas, MD, of Andrews Sports Medicine & Orthopaedic Center in Birmingham, Ala.

Dr. Dugas performed his first UCL repair in 2013. The procedure was of interest to him because he felt Tommy John surgery for some patient's full reconstruction was too intense of a treatment.

Dr. Dugas learned about UCL repair for partial tears and trained on the procedure. He now regularly performs partial UCL repair on high school and collegiate pitchers when their injuries met the criteria.

"Our success rate so far, knock on wood, has been very high," Dr. Dugas said.

Surgeons at Andrews Sports Medicine & Orthopaedic Center have performed approximately 130 UCL repairs since Dr. Dugas performed his first procedure with another hundred procedures done at various clinics across the country.

Mr. Maness is the first professional athlete to opt for UCL repair. He returned to throwing just 7.5 months after his August 2016 surgery — with the median recovery time currently around six months for high school and collegiate players. His progression back to the MLB will be closely followed and critiqued.

"We knew sooner or later the right person would come along and it would get done," Dr. Dugas said. "That person turned out to be Seth Maness."

The future of UCL repair is still volatile. Dr. Dugas said the sports medicine community expects to see failures, and the community has to adapt to those failures.

If Mr. Maness has a successful return, UCL repair will have another advocate; however, if Mr. Maness doesn't come back "this'll look pretty bad," says Dr. Dugas.

For now, Dr. Dugas takes solace in the growing adaptation rate of UCL repair throughout the nation.

"I'm proud of this thing and I'm happy that my elbow surgeon colleagues around the country have adopted this as part of their practice and have had success with it," he said. "We feel good about [the procedure]. I'm confident in it, but we have a lot of proving to do as we expand the applications to see what this is going to look like."

Andrews Sports Medicine & Orthopaedic Center is in the process of publishing its one-year follow-up on the first 40 or 50 patients to undergo the procedure. Dr. Dugas will be in Toronto in July for a sports medicine meeting where he'll present a paper on a biomechanical study of UCL repair.

"We want to come off as cautiously optimistic," Dr. Dugas says. "We don't want to look through rose colored glasses, and we certainly don't want to beat our chests and say this is the greatest thing ever."

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