Repair and Internal Brace Augmentation of the Medial Ulnar Collateral Ligament

The ulnar collateral ligament (UCL) is the primary restraint to valgus stress at the elbow particularly during the late cocking and early acceleration phases of throwing. Injuries to this ligament are being recognized earlier and in younger overhead throwing athletes. These patients represent a different cohort of patients than later career patients with chronic injury who require UCL reconstruction. Many of these younger athletes are able to pursue nonoperative measures successfully to return to sport at an effective level; however, a small subset of athletes require surgical intervention to restore medial elbow stability during overhead throwing. This cohort of patients are candidates for UCL repair which has several benefits outlined in this chapter. This chapter reviews UCL repair history, biomechanics, surgical indications, surgical technique and lastly reviews outcomes of UCL repair in the literature.