PRP and ulnar collateral ligament (UCL) |

Since the earliest papers on ulnar collateral ligament reconstruction, better known as Tommy John Surgery, doctors have sought to improve the method first developed by Dr. Frank Jobe and first performed on the iconic baseball pitcher Tommy John in 1974.

Most recently, doctors reported on a professional baseball player who had Platelet Rich Rich Plasma augmentation on his ulnar collateral ligament reconstruction.

Here is a summary of their case history: Tears of the ulnar collateral ligament (UCL) of the elbow are common injuries in overhead athletes. Although surgical reconstruction of the UCL has improved outcomes, not all athletes return to their previous level of competition and when this goal is achieved, the time required averages one to two years.

Therefore, additional techniques are needed to further improve return to play and the rate of return to play in overhead athletes. A construct comprising a dermal allograft, platelet rich plasma (PRP), and mesenchymal stem cells (MSCs) has been shown to successfully improve healing in the rotator cuff. Given the promising provisional findings, we postulated that this construct could also improve healing if applied to the UCL.

In this case history – No complications were encountered. Although limited to minimal follow-up, the patient has demonstrated excellent progress and has returned to activity (pitching at 86 miles per hour). The full text of this case history is available here: Biologic Augmentation of the Ulnar Collateral Ligament in the Elbow of a Professional Baseball Pitcher 1

In a 1986 paper, Dr. Jobe noted his findings in 16 patients who underwent “Tommy John Surgery.”

  • Reconstruction of the ulnar collateral ligament using a free tendon graft was performed on sixteen athletes.
  • All participated in sports that involved throwing (mostly professional baseball), and all had valgus instability of the elbow.
  • After reconstruction and rehabilitation, ten of the sixteen patients returned to their previous level of participation in sports, one returned to a lower level of participation, and five retired from professional athletics.
  • Despite precautions, there was a high incidence of complications related to the ulnar nerve. Two patients had postoperative ulnar neuropathy (one late and one early) that required a secondary operation, but they eventually recovered completely. 2

In May 2015, nearly 30 years later after the paper cited above, doctors are still trying to improve on the original procedure. In this study from Germany, doctors acknowledged that elbow instability, in this case  that Posterolateral rotatory instability of the elbow is the result of a damaged lateral collateral ligament. The standard surgical technique Single-bundle reconstruction of the lateral ulnar collateral ligament still resulted in cases of recurrent instability after reconstruction. In their desire to improve this technique the doctors found they could not find anything better. “this biomechanical study does not confirm the hypothesis that more anatomic reconstruction techniques (surgeries) could reduce the risk of recurrent instability when compared to conventional  lateral collateral ligament reconstruction.3

Below are resources for information on Elbow instability and alternatives to elboiw reconstruction surgery.  In this article Ross Hauser, MD discusses the realities of Tommy John surgery for baseball players and presents options to surgery. In this paper  Danielle R. Steilen, MMS, PA-C discusses various non-surgical treatment options for elbow instability including Platelet Rich Plasma Therapy and Prolotherapy.

1. Hoffman JK, Protzman NM, Malhotra AD. Biologic Augmentation of the Ulnar Collateral Ligament in the Elbow of a Professional Baseball Pitcher. Case Rep Orthop. 2015;2015:130157. doi: 10.1155/2015/130157. Epub 2015 Jul 9.

2. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am. 1986 Oct;68(8):1158-63.

3. Dargel J, Boomkamp E, Wegmann K, Eysel P, Müller LP, Hackl M. Reconstruction of the lateral ulnar collateral ligament of the elbow: a comparative biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2015 May 10. [Epub ahead of print]