Accessibility Tools
Hide
Menu
Dr Keith Meister, Orthopedic Surgeon, Overhead and Baseball Injury Specialist, Arlington, TX // Services // Elbow // UCL Repair

Surgical Options

Surgical Options 1 Surgical Options 2
  • Standard Reconstruction technique (1974 – Tommy John)
    Tendon grafting
  • Internal Brace repair (2014)
    Ligament repair w/ brace reinforcement
  • The Hybrid Reconstruction (2018)
    Tendon graft + Internal brace

Approach

Approach 1 Approach 2 Approach 3 Approach 4

Ligament Exposure

Ligament Exposure 1 Ligament Exposure 2

Tear Patterns

proximal 1 distal 2 mid 2

Instability

instability1 instability2

Internal Brace Repair(2014)

Internal Brace Repair Internal Brace Repair 2

Who Gets a Primary Repair w/ Internal Brace ?

primary repair 1 primary repair 2
  • Discrete isolated tears off either side of the ligament
  • Healthy looking ligament tissue
  • Healthy Joint cartilage
  • Possible revision situations

Internal Brace Repair

Internal Brace Repair1

Fix the Tear

Fix the Tear1 Fix the Tear2

Secure The Brace

secure1

Internal Brace - Rehab

brace1
  • Brace x 4 wks – Begin ROM after 5-7 days
  • 10 wks postop – Plyos (2 handed / 1 handed)
  • 3 mos postop – Throwing program
  • 4 mos postop – hitting progression
  • 6 mos Postop
    • Position Players, return to play
    • Pitchers 6-8 wk mound progression
    • Catchers progress program x 6 addl wks

Hybrid Reconstruction (2018)

hybrid-reconstruction1
  • Tendon graft + Internal Brace
  • Higher pitching velocities / spin rates forced the need for stronger constructs

Graft Harvest

Palmaris Graft

palmaris-graft

Gracilis Graft

graft1 graft2

Distal Drill Holes

drill

UCL Distal Insertion – Tunnel Adaptation

adaptation

Proximal Drill Holes

drill2

Hybrid Reconstruction

hybrid

Final Graft

final graft

Closure

closure1 closure2

Hinged Elbow Brace

Hinged Elbow Brace1
  • First 6 wks postop
  • Locked for the first week @ 90 degrees
  • Day One:
    • Initiate shoulder program
    • Hand/wrist exercises

Rehabilitation

  • Weeks 1 – 6
    • End of first wk, brace unlocks
    • Weekly increase in brace extension/flexion
    • Begin light total body strengthening
      • Light cardio after first two wks w/ adequate wound healing
    • 1.5 – 3 mos: Progress strengthening / regain elbow ROM
    • 3 mos: initiate more normal wt room workouts
      • Progress shoulder / elbow strength
      • Core / lower body strengthening
    • 4 mos: intiate two handed plyos
    • 5 mos: initiate one-handed plyos

Throwing Program

throwing program
  • 6 Months
    • Begin long toss throwing
    • 45 ft out to 120 feet minimum
    • Velocity based w/ radar gun
  • 9 months
    • Begin mound program
  • 12 months
    • Begin live BP's / simulated game throwing and progress to "real innings"

Over 1 Year Rehab Time

  • 13-14 mos back to full game activity – 13.5 mos avg at pro leve
  • Will keep improving thru the 1st season back
  • > 90 % return to pre-injury level of throwing (HS, College, MLB)
  • No guarantees!!!
  • Must be committed and willing to work hard!

Hybrid Postop

  • Similar rehab to standard reconstruction
  • Throwing programs seem to be a bit smoother
  • Overall results in certain circumstances do seem to be improved

Supplements

Supplements1

Final Do's / Don't's

  • Do: Follow all protocols !!!
  • Don't: No NSAIDs in the postop period
  • Don't: Continue to throw w/ discomfort during rehab!
  • NO TOBACCO PRODUCTS !!!