The Role of Arthroscopy in Athletes with Ulnar Collateral Ligament Injuries

Abstract

Medial elbow pain is common in the overhead throwing athlete. The diagnosis of medial ulnar collateral ligament (MUCL) injuries is mostly based on a history of medial elbow pain, physical examination findings, and imaging studies. The repeated valgus load that causes MUCL attenuation or rupture might also cause ulnar nerve symptoms, posterior impingement, formation of posteromedial osteophytes, formation of loose bodies, stress fractures of the ulna, lateral plica syndrome, trochlea chondromalacia, and less commonly capitellar osteochondritis dissecans (OCD) lesions. Operative treatment of acute MUCL tears or chronic MUCL insufficiency may involve open repair or open graft reconstruction, respectively; however, failure to address concomitant pathology may compromise outcomes of repair/reconstruction. With direct visualization afforded by arthroscopy, the diagnosis and treatment of associated conditions may be accomplished at the time of MUCL repair/reconstruction, making elbow arthroscopy a useful adjuvant in the evaluation and treatment of elbow pain in the overhead athlete. The objective of this chapter is to review the indications and techniques of elbow arthroscopy in athletes with MUCL insufficiency.