Newswise — DETROIT (August 4, 2022) – For young athletes performing repetitive throwing motions, the ulnar collateral ligament (UCL) that runs on the inner side of the elbow is considered a crucial support mechanism for the elbow. When this ligament is torn or damaged, it can cause pain, instability and the inability to throw a baseball.
Overuse contributes to a high rate of arm injuries among youth baseball players. According to a 2015 study published by the American Orthopaedic Society for Sports Medicine, players between the ages of 15 and 19 accounted for nearly 57% of all Tommy John surgeries.
Eric Makhni, M.D., a sports medicine orthopedic surgeon at Henry Ford Health, specializes in new techniques in Tommy John surgery, named after the former professional baseball pitcher who received the first procedure in 1974. The procedure is formally known as UCL reconstruction. The surgical graft procedure involves extracting a healthy tendon from elsewhere in the body and used to replace an arm’s torn ligament. The healthy tendon is threaded through holes drilled into the bone above and below the elbow.
New techniques have evolved since the original elbow reconstruction surgery was developed in the 1970s. Surgeons like Dr. Makhni are now able to “repair” the body’s natural ligament without major reconstruction.
“Primary repair of the UCL has really changed the game in the way we care for these injuries,” said Dr. Makhni. “New techniques have emerged that allow us to actually save the athlete’s native UCL and simply repair it. The UCL is typically supported with an internal brace made of nonabsorbable suture tape that helps protect the repaired ligament while it heals.” Protecting the ligament repair in such a manner allows for a faster recovery to sport when compared to traditional reconstruction techniques.
Choosing between reconstruction and primary repair surgery can be a complex decision. In majority of cases, rest and rehabilitation is an appropriate treatment prior to considering surgery. In cases where there is a significant tear in the UCL, surgery may be the first option.
Dr. Makhni said that while surgery is the best option for some athletes with elbow injuries, most injuries do not require surgery. There are many proven non-operative treatments that can help young pitchers recover and get back to the mound safely, he said. Dr. Makhni also utilizes new biologic treatments such as platelet-rich plasma, which can help the ligament heal after a period of rest. He also reviews strategies with young patients for improving pitching mechanics and arm/core strength that can also help with recovery.
Dr. Makhni has performed several Tommy John reconstruction and repair surgeries on youth baseball players and has led published studies about how better conditioning and throwing mechanics are key to fewer youth pitching elbow injuries. The repair option preserves the native bone in the elbow in the process and, in many cases, pitchers are able return to the mound sooner.
Nic Good is a 19-year-old, left-handed college pitcher who has been able to return to the mound following UCL repair surgery. He has been hurling a baseball since he was 7 years old.
Good underwent the procedure with Dr. Makhni in July 2021 after suffering an injury his senior year of high school baseball, a follow-up MRI revealed a tear in his pitching arm.
“I went to a few different doctors to get opinions, but Dr. Makhni seemed to have done a lot of research and had lots of experience and success with the repair procedure,” said Good. The repair option and shorter recovery time made the decision the right one for him.
The same-day outpatient surgery at Henry Ford Medical Center – Bloomfield Township lasted only a few hours. “Surgery went well with no problems at all, and I felt great afterward,” said Good.
Following a rehab and throwing program provided by Dr. Makhni, Good received medical clearance to start throwing again in March of 2022.
Despite missing the first few weeks of his college freshman season this year, Good made his successful return to the mound on April 3.
“Everything felt great, no problems with my arm,” said Good. “This was my first year of college baseball and I wasn’t sure how it would turn out after the procedure.”
It turned out well. Good finished the season with 7 appearances, 2 starts, 16 innings, 6 strikeouts, 4 shutout innings and reached 91 mph with his pitch velocity. “In high school, the hardest I ever threw was 89 mph,” said Good. “I’m excited to build on this year and see what I can do next season.”
After proper rest this off-season, Good’s main goal is to work his way into the pitching starting rotation and play a full schedule next year.
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American Orthopaedic Society for Sports Medicine