Tips for Successful Ulnar Collateral Ligament Reconstruction
Amar S. Vadhera, BS; Mariano E. Menendez, MD; Zeeshan Khan, BA; Suhas P. Dasari, MD; Matthew R. Cohn, MD; Nikhil N. Verma, MD
Surgical technique video article · Volume 15, Issue 4, Article e22.00029, October to December 2025
Background
The problem this addresses
Ulnar collateral ligament reconstruction has become steadily more common in overhead-throwing athletes, driven by the repetitive valgus stress the throwing motion places on the inside of the elbow, and sometimes by a single acute injury. Athletes with a failing UCL typically notice their pitch velocity and accuracy dropping off, alongside rising fatigue, pain, and a sense of instability in the elbow. The procedure has grown particularly common among young baseball players at high school and college level.
Technique
How the procedure is performed
This article accompanies a video walkthrough of the reconstruction using a hamstring autograft, chosen because it is available in every patient and because published outcomes with it hold up against the alternatives. After the gracilis graft is harvested, the reconstruction is centered on the medial epicondyle with the patient positioned supine. The ulnar nerve is identified and freed, the sublime tubercle is located, and bone tunnels are drilled in the ulna and the epicondyle. The graft is then passed through the ulnar tunnels and docked into the humeral tunnel at both ends, with the limbs sutured together to bring the graft to the correct tension.
View the full surgical technique video article atJBJS Essential Surgical Techniques
Alternatives
When other options apply
Nonoperative management can be appropriate for lower-demand patients, and typically involves rest, physical therapy, a graduated throwing program, a hinged elbow brace, and in some cases biologic injections. For high-volume throwers who intend to return to competitive play, reconstruction is the preferred route.
Outcomes
What patients can expect
A successful reconstruction generally produces high rates of return to play, good patient-reported outcomes, and low rates of revision surgery. In the authors' own experience at Rush, 94 percent of athletes returned to their previous level of play, with a Kerlan-Jobe Orthopaedic Clinic score of 90.4 and an Andrews-Timmerman score of 92.5. The procedure suits patients with significant throwing pain and a strong desire to get back to high-level throwing, since many who step away from the sport can manage ordinary daily activities even with an insufficient ligament.
