J Korean Orthop Assoc.  2023 Apr;58(2):115-123. 10.4055/jkoa.2023.58.2.115 .

Revision Ulnar Collateral Ligament Reconstruction

• Park JY
• Park HK
• Kim Ts

• KMID: 2541466
• DOI: http://doi.org/10.4055/jkoa.2023.58.2.115

Abstract

Although excellent results can be achieved in up to 90% of primary medial elbow ulnar collateral ligament (UCL) reconstructions, retears of the ligament have been reported. As the number of primary reconstructions continues to increase, an increase in the number of revisional UCL reconstructions would be expected. The reported rate of revisional UCL reconstructions varied from 1% to 14%. Revisional UCL reconstruction remains a challenging problem. When ulnar-side bone is compromised from prior surgery, using the previous bone tunnel can still be considered if the bone tunnels can be utilized, spanned, or avoided all together. When the bone bridge is broken, making another bone tunnel along the sublime tubercle on the ulna can be possible sometime. When bone defects are substantial, the cortical button technique or interferential screw technique with a single ulnar tunnel may need to be considered. Studies about the outcome of revisional UCL reconstruction are limited. On the other hand, some studies have shown that the results after revision surgery are not as successful as those after a primary reconstruction. Following a cohort study of Major League Baseball pitchers treated with a revisional UCL reconstruction, only 42% of pitchers returned to pitch more than 10 games. Those who did return to the professional level required 21 months to return. Pitchers who underwent revisional reconstruction had a shorter careers, pitched fewer innings, and had fewer total pitches per season than an age- and position- matched control pitcher group. As the rate of primary UCL reconstruction increases, there has been a corresponding increase in the rate of UCL revision. Many of the same techniques used for primary reconstructions can be used in revision surgery. Nevertheless, the technique may need to be modified or adapted on a case-by-case basis, emphasizing the importance of careful preoperative evaluation.

Keyword

MUCL reconstruction; Revisional MUCL reconstruction; Tommy John surgery; UCL; ulnar bone loss