170: A League of Their Own: Advancements in UCL Surgery

In this deep dive episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Katherine Logan host a live conversation from the 10th annual Arthrex Team Physician Controversy Conference in Naples, Florida, featuring orthopedic surgeons Dr. Neil Elitrash and Dr. Jeff Dugas. The discussion centers on the evolving management of ulnar collateral ligament (UCL) injuries in throwing athletes, highlighting a dramatic shift from routine reconstruction to a more nuanced approach that includes repair with internal brace augmentation. The experts trace the paradigm shift back to earlier failures in Tommy John surgery, advances in surgical technology—particularly from Arthrex—and a growing understanding of UCL anatomy and healing biology. They emphasize that treatment decisions are now driven by individual pathology, timing, and patient goals, with non-surgical options like PRP considered for select partial tears. The internal brace has emerged as a game-changer, especially in revision cases and younger athletes, offering faster recovery and high return-to-play rates (98–99%). The conversation underscores the importance of load-sharing principles, precise surgical technique, and multidisciplinary collaboration in achieving optimal outcomes. Key takeaways include: 1) UCL repair with internal brace augmentation is now a viable, evidence-backed option for select patients with good tissue quality and distal tears; 2) Success hinges on accurate diagnosis, proper patient selection, and avoiding over-tensioning of the internal brace; 3) The rise of hybrid techniques—combining repair with grafts or augmentation—reflects a move toward personalized, biology-driven surgery; 4) Surgeons must master anatomy, especially the medial epicondyle and sublime tubercle, and use tools like pre-sutured allografts to improve efficiency; 5) Team-based care, continuous learning, and peer collaboration are essential for advancing outcomes. The episode ends with a strong message: while the success of modern UCL surgery is transformative, it must be balanced with clinical humility and patient-centered decision-making.