UCL Tear

The ulnar collateral ligament in the elbow connects two bones in the arm, distal humerus and proximal ulna. It provides stability to the medial elbow, especially in overhead athletes. There are three portions to the UCL, anterior oblique, transverse, and posterior ligament. AOL (anterior oblique ligament) plays an important role in providing stability especially in the cocking phase of throwing or tennis serving. This means that it will be under a great deal of stress during such motion. 
       Mechanisms of injury involves valgus stress and traction force from the pronator-flexor mass complex. During baseball pitching, the ligament may be under stress that is close to the maximum torque that it can take. A repetitive stress to the ligament over a period of time may cause a partial or complete tear of the ligament. 
       In younger athletes, their growth plates are the weak link and more prone to an injury. Growth plate injuries instead of ligament injury are more common in those athletes. Medial epicondylar avulsion fractures can happen instead of UCL tear. The sublime tubercle, where UCL inserts on ulna, can also avulse. In addition to valgus stress to the medial part of the elbow, the lateral side of the joint is under compressive force. This force can also cause an injury to the lateral side such as OCD (osteochondritis dessecans). 

       Throwing mechanics plays an important role in reducing such stress to the joint. Certain mechanics are known to put more stress. Thus, it becomes important that overhead athletes are taught the right mechanics at the beginning because it is a lot harder to re-learn the right way after learning faulty motion than to learn the correct mechanics from the beginning.
       Treatment of these conditions include cessation of any overhead activities including throwing, physical therapy to strengthen rotator cuff muscles especially posterior cuff and forearm musculature if it is pain-free, ice, NSAID's to reduce inflammation in an acute phase, etc. Then, gradual interval throwing program should be initiated. If conservative treatment fails, surgical treatment will be necessary. 

MRI image of torn UCL

X-ray of medial epicondylar avulsion fracture

ACL In Preadolescents: Should It Be Reconstructed??

Even though it is still rare, ACL tear in preadolescent athletes are more talked about and diagnosed. A lot more ACL tears in adolescents occur than in preadolescents. However, it is a huge problem to athletes with torn ACL. Whether or not to reconstruct the torn ACL in still controversial.

ACL connects two bone in the knee, femur and tibila, thigh bone and shine bone. It provides stability to the knee and keeps the shine bone from sliding forward on femur and it also prevents excess rotational movements of the knee. Without ACL, athletes will not be likely to perform athletic maneuvers 100% even though there are some who do.

In the preadolescent, their growth plates (physes) are open and still growing. Some doctors are not willing to operate in those athletes. They usually wait until a growth spur occurs to reconstruct the torn ACL. Because there are some reports that growth arrest or other complications may happen if they put a hole through growth plates. There are also reports that say that it is ok to put a hole through growth plates unless a hardware is left in the middle of them. 

There are a few methods to reconstruct ACL without drilling a hope in growth plates. One is to put a graft between epiphyes. Each end of the graft will not reach the growth plate and stopped before. Another way is to take an IT band and use is as a graft. Many orthopedic surgeons will wait until growth spur is finished to reconstruct the torn ACL. One problem that may occur is that leaving a torn ACL in the knee will likely lead to degenerative damage in the knee, thus, leading to premature OA (osteoarthritis). Think about 20 some year old female suffering from OA?! That is not easy. 


In the end, there is no perfect answer to this question, I believe. There are pros and cons either way, early reconstruction or delayed reconstruction. They all should be discussed by the doctor and family member including the injured athlete herself/himself.