What it is
Ulnar collateral ligament reconstruction restores stability to the medial elbow when the ligament is torn and pain or instability persists. A graft is passed through bone tunnels to replace the damaged fibres. The aim is to achieve a stable elbow for high-level throwing.
Rehabilitation is long and structured. It builds range, strength, and throwing skill in stages.
What happens when it occurs
A graft from the forearm, hamstring, or donor tissue is fixed across the joint. Early care protects the graft and restores motion. Strength builds across the shoulder, forearm, and trunk. An interval throwing plan brings velocity and command back step by step.
Common causes and risk factors
- High throwing volumes and high velocity pitching or fast bowling
- Poor trunk and shoulder contribution
- Previous elbow pain or partial tears
- Limited rest between seasons
Who is most affected
Baseball pitchers and cricket fast bowlers. Javelin, water polo, and tennis players are also present.
Typical symptoms before surgery
- Medial elbow pain during late cocking or early acceleration
- Loss of velocity or accuracy
- Apprehension with valgus stress
When to seek care
After ongoing symptoms and failed conservative care, or following acute instability in a thrower who needs high-level return.
How we diagnose
History, moving valgus stress test, imaging with MRI or ultrasound, and sometimes stress X-rays. Assessment of throwing mechanics is essential.
Management
- Brace protection and staged range
- Strength for flexor pronator, rotator cuff, scapular stabilisers, and trunk
- Aerobic conditioning and lower body strength to support volume
- Interval throwing with distance, intensity, and role progressions
- Testing before return to competition
Rehabilitation milestones
Phase 1 weeks 0 to 6: protect graft, restore range, light isometrics.
Phase 2 weeks 6 to 12: progressive strength and control, begin short toss drills without pain.
Phase 3 months 3 to 6: interval throwing, mound or run-up progressions as sport requires.
Phase 4 months 6 to 12: velocity work, command under fatigue, return to competition after testing.
Readiness to progress
- No pain in the position of risk
- External rotation and forearm strength within 90 per cent
- Throwing steps achieved without the next day flare
Long-term care
- Plan season volumes with rest blocks
- Maintain trunk and shoulder power
- Review mechanics at regular points in the year
Australia snapshot
- Seen in baseball and cricket pathways
- Return to competition timelines vary by role and level
- Specialist surgical and sports rehabilitation services are accessible in metropolitan centres
Latest insights
Stability is necessary but not sufficient. Mechanics and workload planning decide durable return.
Trunk and lower body power protect the elbow when velocity rises.
