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The Classic
Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes
  1. Rik J Molenaars1,2,
  2. Nick F J Hilgersom1,2,
  3. Job N Doornberg2,3,4,
  4. Michel P J van den Bekerom5,
  5. Denise Eygendaal2,6
  1. 1 Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
  3. 3 Department of Orthopaedic Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  4. 4 Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
  5. 5 Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  6. 6 Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
  1. Correspondence to Rik J Molenaars, Sports Medicine Center, Harvard Medical School at Massachusetts General Hospital, 175 Cambridge St, Boston, MA 02114, USA; rmolenaars{at}mgh.harvard.edu

Abstract

This classic examines the landmark publication ‘Reconstruction of the Ulnar Collateral Ligament in Athletes’ by Jobe et al, published in 1986. Dr Frank W Jobe was the first to perform and describe a standard technique for ulnar collateral ligament (UCL) reconstruction with the use of a figure-of-eight configuration and submuscular ulnar nerve transposition to treat throwing athletes with UCL insufficiency. Before Jobe’s pioneering work, the initial operative approach to patients with UCL tears involved repair of the native ligament. Despite this treatment, injuries of the UCL were considered career-ending in those days. The original article describes the surgical technique for UCL reconstruction and the postoperative rehabilitation and outcomes in 16 throwing athletes, including Major League Baseball pitcher Tommy John (Los Angeles Dodgers). Jobe reported good results, with 10 of the 16 patients returning to their previous level of participation in sports, one patient returning to a lower level of participation and five patients retiring from professional athletics due to reasons not related to the operation. However, a high incidence of ulnar nerve complications was reported, requiring secondary surgery in two patients. In the decades following the original publication by Jobe et al, modifications of the Jobe technique, involving different graft choices, tunnel positions, and graft configurations and fixation methods have resulted in improved clinical results. Originally presented as a treatment option for elite athletes only, UCL reconstruction has gained public interest as incidence rates of ‘Tommy John surgery’ have reached epidemic proportions, especially in high school-aged baseball pitchers in the USA.

  • sport specific injuries
  • elbow
  • ligament
  • tears
  • repair / reconstruction

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Footnotes

  • Contributors RJM is responsible for critical analysis and interpretation of articles reviewed for the manuscript, manuscript preparation, design, preparation of figures, editing, and obtaining the expert opinions. NFJH is responsible for critical analysis and interpretation of articles and manuscript editing. JND is responsible for manuscript editing. MPJvdB and DE are responsible for manuscript preparation, editing and obtaining the expert opinions.

  • Competing interests JND was supported by an unrestricted research grant from the non-profit Marti-Keuning-Eckhardt Foundation. The other authors (RJM, NFJH, MPJvdB, DE) declare that they have no conflict of interest regarding the publication of this article.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note All images within the article are created by R.J. Molenaars, MD. They are licensed under Creative Commons Attribution NonCommercial 4.0 (https://creativecommons.org/licenses/by-nc/4.0/deed.en). This means that you are free to share and adapt the images if you attribute R.J. Molenaars as the author and do so for non-commercial purposes. You can contact R.J. Molenaars for additional permissions.

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