Tommy John surgery is so common these days that it almost seems like an epidemic. For those unfamiliar with the surgery, it involves reconstructing the Ulnar Collateral Ligament (UCL) of the elbow. This ligament is very important for providing stability of the medial (inside aspect) elbow for athletes who participate in overhead throwing sports (baseball, volleyball, etc). Tearing of the UCL is especially common in pitchers. We used to see it only at the elite level such as in the major leagues. However, this injury is becoming so common that we now see it in collegiate and high school athletes as well. Once the ligament is torn it is virtually impossible for a pitcher to return to high level pitching due to ongoing pain and instability of the elbow. The only available treatment option shown to be successful has been surgical reconstruction of the ligament (Tommy John surgery). While this surgery is successful, it often requires a year of recovery and rehabilitation to return to pitching at an elite level. Without other treatment options available, pitchers with this common injury have had to resort to this surgery at an alarming rate.
Luckily, now there is hope that a non-surgical treatment option is available. PRP treatment has been used with success on partially torn UCL tears. A recent study was presented at the American Orthopedic Society for Sports Medicine (AOSSM) Specialty Day which evaluated 17 athletes with partial UCL tears who had failed conservative treatment including rest and physical therapy. They were then treated with a single PRP injection and 16 out of the 17 athletes were able to return to play within an average time of 10 weeks. Although more research is needed, this data provides evidence that athletes with partial UCL tears may have a better option than going under the knife. Hopefully, with the non-operative treatment option of PRP injections, these athletes will be able to return from injury in less than three months and avoid having to miss an entire year of their sport.
In my own experience I have found that partial UCL tears respond very well to PRP treatment as long as some portion of the ligament remains functionally intact. A thorough physical examination of the elbow including examination under diagnostic ultrasound is very important to determine how unstable the elbow is and to decide whether PRP treatment is a viable option to surgical reconstruction. In appropriate patients I have successfully treated partial UCL tears with a single PRP injection and have allowed them to return to pitching at a professional level within a few months of treatment. I believe that PRP treatment holds tremendous promise for these athletes and will become more widely used in the future.
The above post is a guest post by one of our specialty experts – Dr. Andrew Blecher
