Ulnar collateral ligament reconstruction

PHASE I: Early ROM & Protect Repair (0 to 6 weeks)

Splint and postop dressing remains in place for the first week.
Incision will be inspected by the surgeon at 2 weeks.
Hinged Elbow Brace (HEB) applied at 2-week follow-up visit
Initiate elbow exercise program 5 times per day:
- Passive and active elbow ROM to full flexion
- Elbow extension to 30 (with forearm pronated)
- Forearm pronation/supination ROM with elbow at 90 degrees flexion
Grip and wrist/hand AROM immediately.
Advance terminal extension by 10 degrees per week after week 3 (with forearm supinated)

Discontinue HEB
Advance ROM:
- Full elbow and forearm ROM
- Terminal elbow extension performed with the forearm neutral or pronated until 3 months.
Initiate elbow and forearm strengthening.
Avoid varus forces across the elbow until 3 months postop.
Avoid activities creating axial load to involved extremity until 3 months postop.

Splint and postop dressing remains in place for the first week.
Sutures will be removed by surgeon in 10-14 days.
Night splint (60 degrees flexion) is to be worn at during day and night (after the initial dressing removed)
Initiate elbow exercise program 5 times per day:
- Passive and active elbow ROM to full flexion
- Elbow extension to 30 (with forearm pronated)
- Forearm pronation/supination ROM with elbow at 90 degrees flexion
Grip and wrist/hand AROM immediately.
Avoid terminal 30 degrees extension, perform supination ROM only with the elbow flexed to 90 degrees.

Full elbow and forearm ROM
Terminal elbow extension performed with the forearm neutral or pronated until 3 months.

Initiate elbow and forearm strengthening.
Avoid varus forces across the elbow until 3 months postop.
Avoid activities creating axial load to involved extremity until 3 months postop.

Advance rotator cuff strengthening
Avoid Isokinetic internal rotation strengthening until 6 months
Soft toss 30 to 40 feet with no windup, 10 to 25 minutes per session, 3 days per week
Ice post throwing

Increase tossing distance to 60 feet with no windup, 15 minutes per session, 3 days per week
Ice post throwing

Isokinetic rotator cuff strengthening as tolerated
Easy windup added to throwing, limit distance to 60 feet, 50% effort, 15 minutes per session
Ice post throwing

If cleared by physician, advance to 70 % effort throwing for 30 minutes, 3 days per week

Advance throwing effort to 80% at 9 months from the mound, 30 minute max
Increase to 90-100% at 10 months
Focus on pitching mechanics
No competitive pitching until full progression tolerated well and minimum 11 months post surgery

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