Episode 170: A League of Their Own: Advancements in UCL Surgery

Modern Surgical Management of Elbow UCL Tears

Live from the Arthrex Team Physician Controversies  

🎧 Episode Summary

In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with two leaders in sports medicine—Dr. Neal ElAttrache and Dr. Jeffrey Dugas—to discuss the modern management of ulnar collateral ligament (UCL) injuries in throwing athletes.

Highlights

Changing UCL Injury Landscape

•  Increasing incidence of UCL injuries and surgeries across all levels of play 

•  Notable rise in adolescent and collegiate pitchers

•  Contributing factors include year-round play and high pitch velocity 

Nonoperative Management & Role of PRP

•  Nonoperative treatment remains appropriate for select partial tears 

•  Success varies based on tear grade and location

• PRP discussed as an adjunct to rehab

Indications for Surgery

•  Complete tears—especially in competitive throwers—often require surgical intervention 

•  Tear characteristics (location, tissue quality, chronicity) are critical in decision-making 

UCL Repair with Internal Brace

•  Increasingly utilized in appropriately selected patients

•  Ideal candidates: 

  •  Acute injuries 

  •  Proximal or distal avulsion tears 

  •  Good tissue quality 

•  Advantages: 

  •  High return-to-play (~90%+) 

  • Accelerated recovery timelines (often several months faster) 

UCL Reconstruction (Tommy John Surgery)

•  Remains the gold standard for: 

  •  Chronic degeneration 

  •  Midsubstance tears 

  •  Revision cases 

•  Techniques have evolved over time: 

  •  Docking technique 

  •  Figure-of-eight 

  •  Newer fixation methods (e.g., cortical button techniques) 

•  Autograft (commonly palmaris longus) remains preferred in elite throwers 

Internal Brace Technology

•  Provides added stability and resistance to valgus stress 

•  Supports early rehabilitation while protecting healing tissue 

•  Increasing use in both repair and, selectively, reconstruction 

Key Takeaways

•  UCL injuries are increasing, particularly in younger athletes 

•  Treatment decisions are increasingly personalized based on tear type and athlete profile

•  UCL repair with Internal Brace is shifting the paradigm for select patients 

•  Reconstruction remains essential for more complex or chronic injuries 

Featured Guests

• Dr. Neal ElAttrache – Kerlan-Jobe Orthopaedic Clinic, Head Team Physician for the LA Dodgers & LA Rams 

• Dr. Jeffrey Dugas – Andrews Sports Medicine & Orthopaedic Center, leading expert in UCL repair and reconstruction 

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