Are Suture Spanning Repair Techniques Replacing Traditional Tommy John Surgery? Prevalence and Complication Rates Following Ulnar Collateral Ligament Repair or Reconstruction

Abstract

Background:

Ulnar collateral ligament (UCL) reconstruction has historically been considered the gold standard treatment for severe UCL tears. With the advent of suture-spanning repair techniques, some studies suggest that UCL repair is being performed with increasing frequency. This study provides a large analysis of UCL reconstruction versus repair trends in the United States following the introduction of suture-spanning repair techniques.

Purpose:

To compare the prevalence and complication rates of UCL reconstruction versus repair over a 5-year span following the introduction of suture spanning repair techniques. We also sought to determine if there was an age-related preference for reconstruction versus repair and whether the addition of an ulnar nerve transposition (UNT) affected short-term complication rates.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Using the Merative MarketScan research databases, which contain deidentified patient national claims information, we retrospectively identified patients aged 14 to 30 years who underwent UCL reconstruction or repair between 2016 and 2021, with or without UNT. Patients with a fracture diagnosis at the time of surgery were excluded. Demographic information including age, sex, and geographic region was collected. The number of patients who experienced infection, ulnar neuropathy, device-related complications, and unspecified complications were obtained for each procedure.

Results:

A total of 1191 reconstruction patients and 696 repair patients were identified. 36.8% of patients who underwent either reconstruction or repair had a concomitant UNT. UCL reconstruction patients were approximately 3 years older than repair patients on average (P < .001). Male patients accounted for 89.5% of reconstruction patients and 77.7% of repair patients. From 2016 to 2021, the number of reconstructions declined 32.0% and the number of repairs increased 81.6%. There were no differences in the rate of infection (P = .36) and ulnar neuropathy (P = .73) between reconstruction and repair. The overall risk of developing any complication was higher for repair patients (1.58%) than reconstruction patients (0.67%); however, this difference was not significant (P = .09).

Conclusion:

Between 2016 and 2021, following the introduction of suture spanning UCL repair techniques, the number of UCL repairs increased and the number of reconstructions decreased. There was no difference in complication rates between UCL repair and UCL reconstruction and the rate of complication for either surgery remains low.

Keywords

ulnar collateral ligament elbow complication rate ulnar nerve transposition

Tears of the UCL are often seen in throwing athletes who engage in overhead movements that generate high valgus stress on the medial elbow during the late cocking and acceleration phases of throwing.^10,25 These injuries can also occur in individuals who sustain acute and severe valgus stress, including wrestlers and gymnasts.^12,19

Treatment of UCL tears may begin with nonoperative methods, including a period of rest and strengthening of the flexor-pronator mass. Surgery is indicated for symptomatic patients who fail nonoperative treatment and are willing to participate in lengthy rehabilitation.¹⁹ Recently, the operative management of UCL tears has become more common, with a study reporting an 11-fold increase over the past decade.²⁷ Surgery has traditionally involved reconstruction of the UCL using the modified Jobe, docking, or hybrid interference screw technique.¹⁹ However, there has been an increasing incidence of UCL repair following the introduction of a novel suture spanning technique in 2016.^6,8 A recent study found that the incidence rate ratio of UCL repair compared with reconstruction significantly increased each year over the past decade.³ Another study demonstrated that repairs constituted 23% of UCL tear surgeries in 2010, increasing to 40% by 2020.²⁷ Both studies found that concomitant ulnar nerve procedures occurred in approximately 25% of UCL reconstructions or repairs.^3,27

While operative management, especially repair, of UCL tears is becoming increasingly common, there is a paucity of data examining trends in reconstruction versus repair throughout the entire United States. Furthermore, there is a lack of literature investigating complications after each procedure, as well as the impact of concomitant UNT on the rate of complications.

The primary purpose of this study was to compare the prevalence and complication rates of UCL reconstructions versus repairs after the introduction of suture spanning repair techniques. We also investigated whether there was an age-related preference for reconstruction versus repair. We sought to determine if the type of procedure and the addition of an ulnar nerve procedure affected short-term complication rates. We hypothesized that repairs have become increasingly common over time, while reconstructions have been performed less often with the advent of suture spanning techniques. We hypothesized that younger patients would preferentially receive repair, whereas older patients would more commonly undergo reconstruction. We also hypothesized that reconstruction patients are at higher risk of complication than repair patients and undergoing concomitant UNT increases rate of complication.

Methods

Data for this retrospective study were queried from a database between January 1, 2016, and December 31, 2021. This 5-year range was selected in order to isolate pure reconstruction and repair procedures. Recent use of hybrid techniques combining repair and reconstruction may make the results more difficult to interpret. The Merative MarketScan research database (https://www.merative.com/documents/merative-marketscan-research-databases) is among the largest and most comprehensive, representing >273 million privately insured patients in the United States. UCL reconstruction and UCL repair procedures were identified using International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) codes. UCL reconstructions were obtained from procedure codes 0MR307 and 0MR407 (replacement of elbow bursa and ligament). Numerous codes were used to search for UCL repairs (Appendix Table A1). UNTs were found under code 01S40ZZ (reposition ulnar nerve), and it was noted whether reconstruction and repair patients received concomitant UNT. Of the patients who underwent UCL reconstruction or repair, patients between 14 and 30 years of age with a diagnosis of UCL rupture (S53.3) or sprain (S53.44) were included in the study. Patients with any fracture diagnosis at the time of surgery were excluded. Patient demographic data, including age, sex, and geographic region where the procedure was performed, were collected from the database. The occurrence of complications, including infection, ulnar neuropathy, device-related complications, and unspecified complications, was determined using many ICD-10 Clinical Modification (ICD-10-CM) codes (Appendix Table A2). Complications that occurred within 90 days from surgery were collected for data analysis. Standardized ICD-10 coding was used for identification of both cohorts to minimize selection bias; however, confounding variables and misclassification bias inherent to administrative claims data could not be fully accounted for.

The demographic data were analyzed with descriptive statistics. Welch t test and Fisher exact test were used to confirm if observed differences in age distribution or sex between the procedures were significant. Complication contingency data were also compared using Fisher exact test, as the complications associated with each procedure often affected ≤5 patients. The significance level was set at .05.

Results

Between 2016 and 2021, we found 1191 UCL reconstructions and 696 UCL repairs performed on patients 14 to 30 years of age in the MarketScan database. On average, UCL reconstruction patients were nearly 3 years older than UCL repair patients (P < .001) (Table 1). The age distribution of reconstruction patients is symmetric and normal (Figure 1). However, the repair distribution appears to be positively skewed, further suggesting that the mean repair patient is younger than the mean reconstruction patient. Men accounted for 89.5% of UCL reconstruction procedures and 77.7% of repairs (Table 1). Operatively managed UCL injuries were most frequently observed in parts of the Southeast and Midwest (Figure 2). Alabama, Delaware, and Hawaii were among the states with the highest proportion of UCL procedures performed per 100,000 young patients. The total number of UCL reconstruction procedures declined from 250 cases in 2016 to 170 cases in 2021, showing decreases in both pure reconstruction (UNT–) and combined reconstruction (UNT+). UCL repairs followed an opposite trend, rising from 76 cases in 2016 to 138 cases in 2021, with increases in both the UNT– and the UNT+ subcategories (Figure 3). Of all patients who underwent UCL reconstruction or repair, 36.8% received a concurrent UNT; 39% of reconstruction patients and 32.9% of repair patients were treated with concomitant UNT.

Table 1

Demographic Data for Ulnar Collateral Ligament Reconstruction and Repair Patients ^a

	Type of Surgery
Patient Demographic	Reconstruction(n = 1191)	Repair(n = 696)	P
Age, y	18.73 ± 0.75	16.04 ± 0.13	<.001
Sex			<.001
Male	1066 (89.5)	541 (77.7)
Female	125 (10.5)	155 (22.3)

Data are presented as n (%) or mean ± SE unless otherwise indicated. Bold P values indicate statistical significance.

Figure 1.

Age distribution of patients aged 14 to 30 years receiving ulnar collateral ligament reconstruction and repair procedures.

Figure 2.

Number of surgically treated ulnar collateral ligament injuries per 100,000 privately insured youth (aged 14 to 22 years) in each state. Data were unavailable for North Dakota and Vermont.

Figure 3.

Trends in the number of ulnar collateral ligament reconstruction and repair procedures performed between 2016 and 2021.

The complication rates for reconstruction and repair were very low at 0.67% and 1.58% respectively, indicating the low risk of UCL surgery. The rate of individual complications, including infection and ulnar neuropathy, were also compared between these groups (Figure 4). There were no significant differences in rate of infection (P = .36), rate of ulnar neuropathy (P = .73), or rate of any complication overall (P = .09) between patients receiving any reconstruction procedure (UNT– and UNT+) and patients receiving any repair procedure (UNT– and UNT+). Not shown are the rates of device-related complications and unspecified complications, which can be found in Table 2. Device-related complications were exclusively observed in repair patients. Out of 1191 UCL reconstruction procedures, a single unspecified complication was documented. No unspecified complications occurred following UCL repair. As shown in Figure 5, performing reconstruction with UNT did not affect the rate of infection (P > .99), ulnar neuropathy (P = .08), or any complication (P = .27). Similarly, no differences in rate of infection (P = .25), rate of ulnar neuropathy (P = .60), or any complication (P = .35) were observed between repair with UNT and repair alone (Figure 6).

Figure 4.

Rates of infection, ulnar neuropathy, or any complication in ulnar collateral ligament reconstruction and repair patients.

Table 2

Complications of Ulnar Collateral Ligament Reconstruction and Repair, With or Without a UNT^a

	Reconstruction (n = 1191)		Repair (n = 696)
Total complications	8 (0.67)^b		11 (1.58)^b
Complication	UNT –(n = 726)	UNT +(n = 465)	UNT –(n = 467)	UNT +(n = 229)
Any complication	3 (0.41)	5 (1.07)	6 (1.28)	5 (2.18)
Wound dehiscence	0 (0.00)	0 (0.00)	2 (0.43)	0 (0.00)
Infection	1 (0.14)	1 (0.22)	1 (0.21)	2 (0.87)
Ulnar neuropathy	1 (0.14)	4 (0.86)	2 (0.43)	2 (0.87)
Device related	0 (0.00)	0 (0.00)	1 (0.21)	1 (0.44)
Unspecified	1 (0.14)	0 (0.00)	0 (0.00)	0 (0.00)

Data are presented as n (%) unless otherwise indicated. UNT, Ulnar nerve transposition.

P = .09.

Figure 5.

Rates of infection, ulnar neuropathy, or any complication in reconstruction patients with or without ulnar nerve transposition.

Figure 6.

Rates of infection, ulnar neuropathy, or any complication in repair patients with or without ulnar nerve transposition.

Discussion

We found that the number of repairs has risen as reconstructions have declined in recent years, supporting our hypothesis. We confirmed our hypothesis that younger patients are more commonly treated with repair and that older patients more often receive reconstruction. Despite our prediction that reconstruction patients would be at greater risk, we observed no difference in overall complication rate. Overall, the number of complications in either group was very low. Concomitant UNT did not affect complication rate, leading us to reject our hypothesis that UNT places patients at higher risk. A recent study by Lynch et al¹³ similarly reported equivalent clinical outcomes among reconstruction patients with or without concomitant UNT.

The primary finding of this study was that the prevalence of UCL repairs has increased amid decreases in UCL reconstruction. This trend in reconstruction stands in contrast to other studies, which note a rising rate of reconstruction in professional athletes from 1974 to 2016⁴ and in the general population from 2007 to 2016.² However, trends appear to have changed after 2016. Bi et al³ observed a slight decrease in reconstruction cases and an increase in repairs from 2016 to 2019, mirroring our findings. A study by Solomito et al²³ showed that there was little change in the number of reconstructions performed on 15- to 19-year-olds from 2016 to 2019, and demand for reconstruction for 20- to 24-year-olds actually decreased over the same period. Similarly, a study of college athletes showed a slight decrease in UCL reconstructions each baseball season from 2016 to 2019.²⁰

We suspect that there are 2 reasons for an increase in repairs as reconstructions decline: (1) the development of suture spanning repair constructs that may match the strength of standard reconstruction and (2) the shorter recovery time associated with UCL repair. Early studies that examined repair as an operative treatment for UCL tear reported unfavorable results.^1,5 However, recent literature implementing these novel repair constructs also demonstrated biomechanical strength⁸ and outcomes²² comparable with a standard reconstruction. Additionally, patients who receive UCL reconstruction generally return to sport within 11 to 12 months^21,24 but may require up to 16 months.¹¹ In contrast, repair patients may experience a 6- to 9-month recovery.^7,15 The indications for when to choose a repair with suture spanning techniques versus graft reconstruction continue to evolve. Decision regarding the type of surgery is dependent on several factors including, but not limited to, injury chronicity, patient age, sport, level of play, and expected throwing demand, among others. Although the prevalence of reconstruction is declining, it is still a highly effective technique for treating severe or complete UCL tears and remains more common than repair.

Existing literature broadly examines the age distribution of patients receiving either procedure, spanning from <18 to >59 years.^2,9 In this study, we focus on 14- to 30-year-olds to better understand a disproportionately affected population. Erickson et al⁹ and Mahure et al¹⁴ have observed that the incidence of reconstruction is much higher among younger patients, particularly those aged 15 to 19 years. There is growing evidence that the mean age of patients receiving either reconstruction or repair has dropped considerably in recent years.^17,26 Within this younger cohort, we found that UCL repair patients were approximately 3 years younger than reconstruction patients on average. Although younger patients have less native bone present for osseous tunnels, we propose that surgeons are more likely to recommend repair to patients aged <16 because of concerns about potential physeal growth arrest. Additionally, younger patients are often more suited to repair because they typically have more robust ligaments, having experienced fewer years of ligament attrition from throwing sports. These younger patients aged <16 may also be more likely to have partial ligament injuries, which are not severe enough to require UCL reconstruction. Older patients may undergo reconstruction at a high rate due to poorer quality of the native ligament with chronic changes including calcification, hypertrophy or attrition, and periligamentous edema or thickening. It is also possible that repair is sufficient for younger athletes throwing at lower rates of velocity and workload, whereas UCL reconstruction may be more resilient to chronic workloads. The design of this study only allows us to detect an age-related preference, but future studies could explore whether this preference is based on the demands that younger and older patients place on the UCL.

We observed a high number of UCL procedures per capita in 3 states: Alabama, Delaware, and Hawaii. Home to several high-volume, prominent shoulder and elbow surgeons and such centers as Andrews Sports Medicine, Alabama is a destination state for UCL surgery. However, Delaware and Hawaii are not particularly high-volume states for UCL procedures. Because both states have small populations, small variations in the number of privately insured patients aged 14 to 30 could skew the incidence of UCL surgery artificially high. These observations suggest that the geographic distribution shown in Figure 2 may have limited accuracy for less populous states.

There was no difference in complication rates between repair and reconstruction patients. Despite being a potentially shorter and less complex procedure, repairs do not seem to confer protection from complication. As indications for UCL repair expand and surgeons utilize the procedure more frequently, we may observe that complication rates for repair increase overall. Additionally, undergoing concomitant UNT did not place repair or reconstruction patients at elevated complication risk. In general, regardless of procedure, UCL surgery is safe with low risk of complications.

As a database study, we are inherently limited in our ability to comprehensively capture all complications. Although several studies agree that reconstruction and repair are safe procedures with low complication rates, they reported slightly higher rates of complication than what we found. Nagy et al¹⁶ observed complication rates of 8.59% for modified Jobe reconstruction and 2.35% for docking reconstruction, with the present study showing a rate 0.67%. A systematic review by Puga et al¹⁸ reported complication rates between 5.3% and 11.9% for repair, compared with our 1.58%.

Limitations

This study has limitations on generalizability. The database represents a subsection of the US population and only contains privately insured patients, who are known to undergo surgical intervention more often than patients with public insurance. Database information is limited by the accuracy of coding and billing, and patients become active in the database after 18 to 24 months. Although athletes and baseball players likely account for a large portion of 14- to 30-year-old UCL injury patients, we cannot draw direct conclusions about this population from the study. Patients who had both reconstruction and repair codes were entered as reconstruction. This is a limitation of the study; however, hybrid procedures were not very common in the time frame of this study. The database cannot determine whether patients sustained chronic attritional UCL injuries like those commonly observed in overhead throwing athletes, or acute traumatic injuries characteristic of wrestlers and gymnasts. The database did not specify whether UCL tears were proximal, distal, or midsubstance, which is an important factor in a surgeon's decision to perform a repair. For example, a tear on the well-vascularized proximal UCL is much more amenable to repair than a distal tear. Repair may not be suitable for a midsubstance tear in a throwing athlete but may be appropriate for the same midsubstance tear in an average patient who does not participate in sports. The database does not include information regarding whether or not a repair included a suture spanning construct nor does it include outcome data, such as time to return to play or performance metrics. However, for many surgeons who perform both UCL repair and UCL reconstruction for athletes and nonathletes, the use of suture spanning augmentation has increased substantially since the concept was introduced by Dugas⁶ in 2016. Another limitation is that indications for surgery and factors affecting treatment decisions were not included. Although the database specifies whether a procedure included a concomitant UNT, it is unknown whether patients received either a decompression or a transposition. As techniques evolve and surgeons begin to incorporate suture spanning augmentation techniques in reconstructions, this kind of analysis will become less insightful because there is no CPT code for a combined procedure.

Conclusion

Between 2016 and 2021, following the introduction of suture spanning UCL repair techniques, the number of UCL repairs increased, and the number of reconstructions decreased. There was no difference in complication rates between UCL repair and UCL reconstruction, and the rate of complication for either surgery remains low.

Footnotes

Appendix

Table A2

International Classification of Diseases, Tenth Revision, Clinical Modification, Codes for the Complications of UCL Reconstruction and Repair ^a

Wound Dehiscence
T81.30XA	T81.30XD	T81.30XS	Disruption of surgical wound
T81.31XA	T81.31XD	T81.31XS
T81.328A	T81.328D	T81.328S
T81.329A	T81.329D	T81.329S
T81.33XA	T81.33XD	T81.33XS
Infection
T81.12XA	T81.12XD	T81.12XS	Postprocedural septic shock
T81.40XA	T81.40XD	T81.40XS	Infection following procedure
T81.41XA	T81.41XD	T81.41XS
T81.42XA	T81.42XD	T81.42XS
T81.44XA	T81.44XD	T81.44XS
T81.49XA	T81.49XD	T81.49XS
T84.7XXA	T84.7XXD	T84.7XXS	Infection or inflammatory response due to device, implant, or graft
Ulnar Neuropathy
S44.00XA	S44.00XD	S44.00XS	Injury of nerves at shoulder/upper arm level
S44.01XA	S44.01XD	S44.01XS
S44.02XA	S44.02XD	S44.02XS
S54.00XA	S54.00XD	S54.00XS	Injury of nerves at forearm level
S54.01XA	S54.01XD	S54.01XS
S54.02XA	S54.02XD	S54.02XS
Device-Related Complications
T84.84XA	T84.84XD	T84.84XS	Pain due to device, implant, or graft
T84.89XA	T84.89XD	T84.89XS	Other specified complication of device, implant, or graft
Unspecified Complications
T81.89XA	T81.9XXA	T88.8XXA
T81.89XD	T81.9XXD	T88.8XXD
T81.89XS	T81.9XXS	T88.8XXS
T88.9XXA	T88.9XXD	T88.9XXS

UCL, ulnar collateral ligament.

Final revision submitted April 6, 2026; accepted April 28, 2026.

One or more of the authors has declared the following potential conflict of interest or source of funding: J.K.E. has received fees for advice or consultation with Arthrex Inc, has received travel reimbursement, and is on the editorial board of the Journal of Arthroscopy. R.J.F. has received fees for advice or consultation with Advita Inc, speaking and lecture fees, and travel reimbursement.

Ethical approval was not sought for the present study.

ORCID iDs

Mitchell H. Negus

Matthew E. Guareschi

Lauren Wohlrab

Trevor Wolterink

Robert J. Reis

Brandon L. Rogalski

Richard J. Friedman

Kit N. Simpson

Josef K. Eichinger

References

Azar

Andrews

Wilk

Groh

Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med. 2000;28(1):16-23.

Baron

Westermann

DeMik

Wolf

BR.

Trends in medial ulnar collateral ligament repair and reconstruction from 2007 to 2016: a population-based study of a large private insurance database. HSS J. 2022;18(1):116-121.

Lin

Anil

Rokito

Jazrawi

Erickson

BJ.

Trends in elbow ulnar collateral ligament repairs and reconstructions and an analysis between low- and high-volume surgical centers: a 10-year study in New York State. Orthop J Sports Med. 2024;12(5):23259671241246811.

Camp

Conte

D'Angelo

Fealy

SA.

Epidemiology of ulnar collateral ligament reconstruction in Major and Minor League Baseball pitchers: comprehensive report of 1429 cases. J Shoulder Elbow Surg. 2018;27(5):871-878.

Conway

Jobe

Glousman

Pink

Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74(1):67-83.

Dugas

JR.

Ulnar collateral ligament repair: an old idea with a new wrinkle. Am J Orthop (Belle Mead NJ). 2016;45(3):124-127.

Dugas

Looze

Capogna

, et al. Ulnar collateral ligament repair with collagen-dipped FiberTape augmentation in overhead-throwing athletes. Am J Sports Med. 2019;47(5):1096-1102.

Dugas

Walters

Beason

Fleisig

Chronister

JE.

Biomechanical comparison of ulnar collateral ligament repair with internal bracing versus modified Jobe reconstruction. Am J Sports Med. 2016;44(3):735-741.

Erickson

Nwachukwu

Rosas

, et al. Trends in medial ulnar collateral ligament reconstruction in the United States: a retrospective review of a large private-payer database from 2007 to 2011. Am J Sports Med. 2015;43(7):1770-1774.

10.

Gehrman

Grandizio

LC.

Elbow ulnar collateral ligament injuries in throwing athletes: diagnosis and management. J Hand Surg. 2022;47(3):266-273.

11.

Keller

Marshall

Limpisvasti

DeGiacomo

Banffy

ElAttrache

NS.

Medial elbow pain during the return-to-throwing period after ulnar collateral ligament reconstruction in pitchers. Orthop J Sports Med. 2018;6(11):2325967118808782.

12.

Goodman

Lemme

Owens

BD.

Epidemiology of elbow ulnar collateral ligament injuries in throwing versus contact athletes of the National Collegiate Athletic Association: analysis of the 2009-2010 to 2013-2014 seasons. Orthop J Sports Med. 2019;7(4):2325967119836428.

13.

Lynch

Johnson

Ciccotti

, et al. Clinical outcomes after ulnar collateral ligament reconstructions with concomitant ulnar nerve transposition in overhead athletes: a matched cohort analysis. Am J Sports Med. 2023;51(4):919-925.

14.

Mahure

Mollon

Shamah

Kwon

Rokito

AS.

Disproportionate trends in ulnar collateral ligament reconstruction: projections through 2025 and a literature review. J Shoulder Elbow Surg. 2016;25(6):1005-1012.

15.

Mastroianni

Dillon

Reyes

, et al. Return to play and performance following UCL reconstruction and repair in Major League Baseball position players. Orthop J Sports Med. 2026;14(3):23259671251413601.

16.

Nagy

Alexander

Liu

A systematic review of surgical outcomes of ulnar collateral ligament rupture in the elbow treated with various techniques. J Orthop. 2025;64:1-6.

17.

Petty

Andrews

Fleisig

Cain

EL.

Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. Am J Sports Med. 2004;32(5):1158-1164.

18.

Puga

Box

Pautler

Perleberg

Poffenbarger

Riehl

JT.

Elbow ulnar collateral ligament repair: a systematic review of trends and outcomes. JSES Rev Rep Tech. 2025;5(4):960-967.

19.

Rahman

Levine

Ahmad

CS.

Elbow medial collateral ligament injuries. Curr Rev Musculoskelet Med. 2008;1(3-4):197-204.

20.

Rothermich

Fleisig

Conte

Hart

Cain

Jr Dugas

JR.

Short-term trends in elbow ulnar collateral ligament surgery in collegiate baseball players: an analysis of 25,587 player-years. Orthop J Sports Med. 2021;9(7):23259671211016846.

21.

Saper

Shung

Pearce

Bompadre

Andrews

JR.

Outcomes and return to sport after ulnar collateral ligament reconstruction in adolescent baseball players. Orthop J Sports Med. 2018;6(4):2325967118769328.

22.

Savoie

3rd Trenhaile

Roberts

Field

Ramsey

JR.

Primary repair of ulnar collateral ligament injuries of the elbow in young athletes: a case series of injuries to the proximal and distal ends of the ligament. Am J Sports Med. 2008;36(6):1066-1072.

23.

Solomito

Kostyun

Sabitsky

Nissen

CW.

Trends in ulnar collateral ligament injuries and surgery from 2010 to 2019: an analysis of a national medical claims database. Orthop J Sports Med. 2024;12(11):23259671241290532.

24.

Thomas

Paul

Rosen

, et al. Return-to-play and competitive outcomes after ulnar collateral ligament reconstruction among baseball players: a systematic review. Orthop J Sports Med. 2020;8(12):2325967120966310.

25.

Torres

Limpisvasti

Ulnar collateral ligament repair of the elbow—biomechanics, indications, and outcomes. Curr Rev Musculoskelet Med. 2021;14(2):168-173.

26.

Wilk

Thomas

Arrigo

Campbell

Shahien

Dugas

JR.

The use of the internal brace to repair the UCL injury of the elbow in athletes. Int J Sports Phys Ther. 2022;17(7):1208-1218.

27.

Willenbring

Epner

Warth

Gregory

JM.

Increasing rates of ulnar collateral ligament repair outpace reconstruction in isolated injuries: review of a Texas surgical database. JSES Int. 2023;7(1):192-197.