Elbow Ligament Repair
Elbow ligament tear surgery is performed to repair or reconstruct damaged ligaments in the elbow, most commonly the ulnar collateral ligament (UCL) or the lateral collateral ligament (LCL). These ligaments are crucial for maintaining elbow stability, especially in athletes and individuals who use repetitive arm movements like throwing or lifting.
The elbow is stabilized by several ligaments:
| Ligament | Location | Function |
| Ulnar Collateral Ligament (UCL) | Inner (medial) side of the elbow | Resists valgus stress (forces pushing the forearm outward) |
| Lateral Collateral Ligament (LCL) | Outer (lateral) side | Resists varus stress (inward forces); prevents dislocation |
| Annular Ligament | Surrounds the radial head | Allows rotation of the forearm |
Types of Elbow Ligament Tear Surgeries
- Ulnar Collateral Ligament (UCL) Reconstruction
Also known as Tommy John Surgery
- Most common in baseball pitchers and overhead athletes
- Replaces the torn UCL with a tendon graft (usually from the forearm, hamstring, or a donor)
- Restores valgus stability needed for throwing
- Lateral Collateral Ligament (LCL) Repair or Reconstruction
- Common after elbow dislocations or trauma
- LCL repairs are performed in cases of posterolateral rotatory instability (PLRI)
- If ligaments are severely damaged, tendon grafts are used
- Primary Repair (if injury is recent and tissue is healthy)
- Ligament is re-attached to the bone using suture anchors
- More common in acute injuries in younger individuals
Clinical Pathway
- You will be seen by the specialist in outpatient department for clinical evaluation.
- You will be asked certain questions related to your symptoms and examined thoroughly.
- Your investigations such as X-ray, CT, MRI will be reviewed, following which a surgical plan of surgery will be made.
- A detailed explanation will be given to you with regards to surgery along with its pros and cons.
- You will be seen by the anesthetic team
- Your fitness for surgery will be evaluated.
- Investigations including blood tests will be carried out.
- A physical therapist will explain you with regarding to the post op precautions, exercises and immobilization.
- You will be admitted on the day of surgery in the morning. The surgery will be performed under general and regional anesthesia.
- After surgery, you will be under certain medication to control your post operative pain to make you comfortable.
- You will be discharged in next two to three days with post operative instructions.
- Your physical therapy will be started on the next day after surgery and will continue for around three months.
- You will be required to see the specialist in outpatient clinic on couple of occasions to assess the recovery. You were expected to recover completely in approximately three to six months.
To summarise, elbow arthroscopy is a minimally invasive procedure used for pain, stiffness, arthritis, loose bodies, tendon issues and causes Less pain, faster recovery, smaller scars than open surgeries, with high success rate when performed for appropriate conditions.
Frequently Asked Questions
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Common Causes of Elbow Ligament Tears
• Repetitive stress or overuse (common in throwing athletes) • Acute trauma or dislocation • Degeneration over time • Elbow hyperextension injuries • Direct impact to the elbow
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Symptoms of Ligament Tears
• Pain (medial pain for UCL, lateral for LCL) • Instability or feeling of the elbow "giving out" • Decreased throwing velocity or accuracy (in athletes) • Swelling or stiffness • Difficulty lifting, pushing, or rotating the arm
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How is it diagnosed
Clinical Evaluation: • History of symptoms, physical examination • Valgus stress test (for UCL) • Varus stress test (for LCL) • Moving valgus stress test Imaging: • MRI: Best for assessing soft tissue damage • Ultrasound: Dynamic evaluation of ligament function • X-rays: Rule out fractures or bone alignment issues
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Can a ligament tear be treated without surgery
Non-Surgical Treatment is usually the first-Line treatment for partial tears • Rest and activity modification • Anti-inflammatory medications • Bracing or splinting • Physical therapy (to improve strength and range of motion) • PRP (platelet-rich plasma) injections in some cases If symptoms persist or the ligament is completely torn, surgery is often recommended—especially for athletes or active individuals.
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What does the surgery involve
1. Anesthesia: General or regional 2. Incision: Along the inside of the elbow 3. Nerve protection: The ulnar nerve may be moved or protected 4. Harvest graft: Tendon (e.g., palmaris longus or hamstring) is taken 5. Bone tunnels: Small holes drilled in humerus and ulna 6. Graft passed through tunnels in a figure-8 or docking configuration 7. Fixation: Graft secured with sutures or screws 8. Closure: Skin closed, bandaged, and immobilized Procedure may vary depending on whether it’s a repair or reconstruction, and which ligament is involved.
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Recovery Timeline
Phase Timeframe Goals Immobilization 1–2 weeks Protect surgical site, reduce swelling Early Rehab 2–6 weeks Gradual ROM (range of motion) exercises Strengthening 6–12 weeks Begin light resistance exercises Advanced Rehab 3–6 months Functional training, sport-specific movements Return to Sport 9–12+ months Gradual return to full athletic activity Overhead athletes typically return to competition after 12–18 months post-UCL reconstruction.
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Risks and Complications
Complication Description Infection Rare with proper sterile technique Nerve injury Ulnar nerve most at risk (may cause numbness/tingling) Stiffness Scar tissue formation can limit motion Graft failure Re-tear of the reconstructed ligament
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Post-Surgical Guidelines
• No lifting or throwing during early healing • Gradual, supervised rehab is critical • Follow restrictions on elbow extension or rotation • Watch for numbness, swelling, or instability
