Elbow ulnar collateral ligament injuries in athletes: Can we improve our outcomes?

Table 3 High speed steels postoperative rehabilitation protocol following ulnar collateral ligament reconstruction with palmaris longus autograft

Time period	Treatment strategies	Goal
Day 0-10	Splinted or hinged elbow ROM brace at 60 degrees flexion	Promote graft healing, reduce pain, and swelling
Weeks 1-4	Hinged elbow ROM brace at all times No PROM Elbow AROM in brace	Restore ROM 30°-90° Promote graft healing Independent home exercise program
Weeks 4-6	Continue brace wear at all times Avoid PROM Avoid valgus stress Continue AROM in brace Isometric exercises of deltoid, wrist, elbow	Restore ROM 15°-115° Minimal pain and swelling
Weeks 6-12	Minimize valgus stress Avoid PROM by the clinician Avoid pain with exercises Continue AROM Low intensity, long duration stretch for extension Isotonic exercises of the scapula, shoulder, elbow, forearm and wrist Eccentric training when strength is adequate	Restore full ROM All upper extremity strength 5/5 Begin to restore muscular endurance
Week 8	Begin internal/external rotation strengthening Begin forearm pronation/supination strengthening
Weeks 12-16	Pain free plyometric exercises Advance internal/external rotation to 90/90 position Neuromuscular drills Plyometric program Endurance training	Restore full strength and flexibility Prepare for return to activity
Week 16	Begin interval throwing program
Weeks 16-36	Avoid pain with throwing or hitting Avoid loss of strength or flexibility Continue flexibility training Continue strengthening program	Return to activity Prevent reinjury
Week 20	Begin hitting program

ROM: Range of motion; AROM: Active range of motion; PROM: Passive range of motion.