Rehabilitation Following Ulnar Collateral Ligament Reconstruction in Overhead-Throwing Athletes

Abstract

» The prevalence of ulnar collateral ligament (UCL) injury and UCL reconstruction (UCL-R) continues to rise, causing morbidity in overhead-throwing athletes.» Postoperative rehabilitation protocols are essential for proper healing of the reconstructed ligament and safely returning athletes to competition, yet there is no uniformly accepted standard of care.» UCL-R rehabilitation has traditionally been guided by expert opinion and conventional wisdom rather than scientific studies, resulting in substantial variability in rehabilitation practices, time to return to play, and outcomes.» Current research efforts aim to closely investigate the biomechanical implications of UCL-R and overhead throwing to better guide rehabilitation and to improve competitive performance and outcomes.» Additional biomechanical and scientific studies on rehabilitation modalities and timing are warranted for systematic analysis, optimization, and standardization of UCL-R rehabilitation.

Rehabilitation and Return to Play of the Athlete after an Upper Extremity Injury

“…Despite no standard consensus on an evidence-based protocol, many studies have reviewed the available literature to identify the core principles of recovery. [74][75][76][77] Current principles of UCL reconstruction (UCL-R) can be divided into 4 phases: (1) immediate postoperative, (2) intermediate strengthening, (3) advanced strengthening, and (4) return to activity. 75,77 The first phase (weeks 0 to 3) is directed at protecting the healing graft and gradual restoration of elbow ROM.…”

“…[74][75][76][77] Current principles of UCL reconstruction (UCL-R) can be divided into 4 phases: (1) immediate postoperative, (2) intermediate strengthening, (3) advanced strengthening, and (4) return to activity. 75,77 The first phase (weeks 0 to 3) is directed at protecting the healing graft and gradual restoration of elbow ROM. 75,77 A systematic review by Lightsey et al 74 analyzed 30 rehabilitation protocols after UCL-R and found that most protocols recommend immediate splinting of the elbow at 90 for approximately 2 weeks, followed by a functional brace to be worn until approximately 4 to 6 weeks semioperatively.…”

“…75,77 The first phase (weeks 0 to 3) is directed at protecting the healing graft and gradual restoration of elbow ROM. 75,77 A systematic review by Lightsey et al 74 analyzed 30 rehabilitation protocols after UCL-R and found that most protocols recommend immediate splinting of the elbow at 90 for approximately 2 weeks, followed by a functional brace to be worn until approximately 4 to 6 weeks semioperatively. Once preinjury ROM is restored and pain has subsided, the second phase (intermediate strengthening) may be initiated.…”

“…Once preinjury ROM is restored and pain has subsided, the second phase (intermediate strengthening) may be initiated. 75,78,79 The intermediate strengthening phase (weeks 4 to 7) involves gradual increases in upper-extremity mobility, muscular strength, and increasing resistance to valgus stress. 75,77 Once strength of the operative extremity reaches 70% of the uninjured extremity, the advanced strengthening phase is initiated.…”

“…75,78,79 The intermediate strengthening phase (weeks 4 to 7) involves gradual increases in upper-extremity mobility, muscular strength, and increasing resistance to valgus stress. 75,77 Once strength of the operative extremity reaches 70% of the uninjured extremity, the advanced strengthening phase is initiated. 75 The advanced strengthening phase (weeks 8 to 14) is comprised of increasing muscle strength, durability, and neuromuscular control.…”