Failed UCL Surgery

Failed UCL surgery occurs when the initial surgical repair or reconstruction of the UCL does not result in the desired outcomes. This can include a failure to restore the ligament’s stability, continued pain, or the inability to return to previous levels of athletic performance.

• Persistent pain is the most frequently cited reason for UCL repair failure.
• Instability or a feeling of looseness, especially when throwing or lifting.
• Decreased range of motion.
• Swelling and inflammation.
• Weakness.

Several factors can contribute to the failure of UCL surgery:

• Surgical Technique: Errors during the surgical procedure, such as improper placement of grafts, anchors, or tunnels, can lead to failure.
• Rehabilitation Issues: Inadequate or overly aggressive rehabilitation can impede proper healing and ligament integration.
• Reinjury: Returning to high-stress activities too soon or a new injury to the repaired ligament can cause failure.
• Biological Factors: Individual variations in healing response or issues like limited graft remodeling or poor vascular supply can affect the success of the surgery.

To determine whether revision UCL reconstruction or repair is appropriate, Dr. Waterman must determine the cause of failure. A complete review of the patient’s medical history, previous surgery, symptoms, and rehabilitation are performed. He will review operative reports and prior imaging and conduct a thorough orthopedic examination. New imaging studies will be obtained, including MRI and CT scans to visualize the UCL and surrounding structures, and ultrasound stress tests can be selectively considered. With all of this information, he will determine the best option for repair or revision for each athlete.

The treatment approach varies based on the cause of failure, including technical errors, patient factors, rehabilitation problems, or graft failure. Initial treatment for a failed UCL surgery is conservative measures, including rest, activity modification, physical therapy, anti-inflammatory medications, and bracing or splinting. Orthobiologics treatments such as injections with platelet-rich plasma or bone marrow aspirate therapy may be recommended. Surgery may be recommended if conservative measures fail or if the failed UCL surgery involves elite overhead athletes.

Surgical Interventions:

• Revision UCL reconstruction involves a second surgical procedure to repair or reconstruct the UCL. This can involve using a different type of graft, such as:
• • Autograft: Tissue taken from another part of the patient’s body, often from the palmaris longus tendon in the forearm or the hamstring tendon.
  • Allograft: Donor tissue from a cadaver, used when autograft options are limited or if the patient has already undergone multiple surgeries.
• Modified Surgical Techniques: Surgical repair and/or reconstruction of the UCL showed a low complication rate. Utilizing repair surgical techniques or approaches that were not used in the initial surgery may be a valuable alternative to treat failed UCL surgery.

1. • Internal Brace Technique: This involves augmenting the reconstructed ligament with synthetic tape, which provides additional support and allows for quicker rehabilitation.
   • Docking Technique: A method that ensures more secure graft fixation, reducing the likelihood of failure.

Studies report that athletes undergoing revision UCL reconstruction had a high return to play rate of 77%, but only 55% of players returned to their same level of play. Professional baseball pitchers with faster pitch velocity are at greater risk of elbow injury and subsequent ulnar collateral ligament reconstruction.