From the Research
Surgical intervention is recommended for displaced avulsions or cases with significant instability in young athletes with UCL avulsion, as it provides better long-term stability and higher rates of return to pre-injury performance levels 1. The treatment plan for an ulnar collateral ligament (UCL) avulsion in a young athlete typically begins with a thorough evaluation including physical examination and imaging studies such as MRI or ultrasound to confirm the diagnosis.
Key Considerations
- For non-displaced avulsions with minimal instability, conservative management may be attempted first, consisting of 4-6 weeks of immobilization in a hinged elbow brace, followed by a progressive rehabilitation program 2.
- Pain management includes NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks.
- Surgical intervention, typically involving reattachment of the ligament to the medial epicondyle using suture anchors or screws, is often preferred for competitive athletes as it provides better long-term stability and higher rates of return to pre-injury performance levels 1.
Post-Surgical Rehabilitation
- Post-surgical rehabilitation follows a phased approach:
- Phase 1 (weeks 0-4) focuses on protected range of motion and pain control.
- Phase 2 (weeks 4-8) introduces progressive strengthening.
- Phase 3 (weeks 8-12) incorporates sport-specific exercises.
- Phase 4 (months 3-6) involves a gradual return to throwing program.
Decision Making
- The decision between conservative and surgical management should consider the athlete's age, competitive level, and future athletic goals 3.
- Return-to-play rates after UCL reconstruction reported in the literature have ranged from 33% to 92%, with a recent systematic review noting a return-to-play rate of 89.40% in all high school athletes 1.