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. 2025 May-Jun;17(3):460-469.
doi: 10.1177/19417381241249125. Epub 2024 May 3.

Rehabilitation Protocols in Elbow Medial Ulnar Collateral Ligament Injuries: A Systematic Review of Articles Published in the Last 20 Years

Timothy R Buchanan  1 , Keegan M Hones  2 , Kevin A Hao  1 , Sravya Kamarajugadda  1 , Brandon Portnoff  3 , Jonathan O Wright  2 , Joseph J King  2 , Thomas W Wright  2 , Jongmin Kim  2 , Bradley S Schoch  4 , Ryan P Roach  2 , William R Aibinder  5
Affiliations

Rehabilitation Protocols in Elbow Medial Ulnar Collateral Ligament Injuries: A Systematic Review of Articles Published in the Last 20 Years

Timothy R Buchanan et al. Sports Health. 2025 May-Jun.

Abstract

Context: Elbow medial ulnar collateral ligament (UCL) injuries have become increasingly common in athletes. Despite this, rehabilitation protocols appear to vary drastically, which may explain the clinical equipoise regarding optimal management.

Objective: This systematic review reports rehabilitation characteristics reported after UCL injuries and compares reported outcomes based on early versus delayed rehabilitation.

Data sources: Our search utilized PubMed/MEDLINE, Embase, Web of Science, and Cochrane to identify all articles on UCL rehabilitation published between January 1, 2002 and October 1, 2022.

Study selection: Studies in English with ≥5 patients that reported rehabilitation protocols for UCL injuries were evaluated.

Study design: Systematic review.

Level of evidence: Level 4.

Data extraction: Data included sample characteristics, time to achieve physical therapy milestones, outcome scores, and return-to-play (RTP) rate and timing.

Results: Our review included 105 articles with a total of 15,928 elbows (98% male; weighted mean age, 23 years; follow-up, 47 months), with 15,077 treated operatively and 851 treated nonoperatively. The weighted mean time patients spent adhering to nonweightbearing status was 42 days. The mean time until patients were given clearance for active range of motion (ROM) 15 days, full ROM 40 days, and elbow strengthening exercises 32 days. The mean time until all restrictions were lifted was 309 days. The mean time to begin a throwing program was 120 days. Across all rehabilitation characteristics, protocols for patients undergoing nonoperative management started patients on rehabilitation earlier. After UCL reconstruction, earlier active ROM (≤14 days), elbow strengthening (≤30 days), no restrictions (≤180 days), and throwing (≤120 days) postoperatively led to earlier RTP without a negative effect on functional outcome scores.

Conclusion: Current literature provides a spectrum of protocols for elbow UCL rehabilitation, regardless of management. Nonoperative patients began ROM activities, strengthening, and throwing programs sooner than operative patients, and earlier milestones led to earlier RTP.

Keywords: MUCL; UCL; physical therapy; sports; upper extremity.

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Conflict of interest statement

The following authors declared potential conflicts of interest: K.A.H. has received consulting fees from LinkBio Corp. J.J.K. has received consulting fees from Exactech and LinkBio Corp. J.O.W. has received consulting fees and royalties from Exactech. B.S.S. has received royalties from Exactech, Innomed, and Responsive Arthroscopy. R.P.R. has received academic support from Arthrex. W.R.A. has received consulting fees from Exactech.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram depicting article identification, subsequent exclusion, and analysis for outcomes and complications. PRISMA, preferred reporting items for systematic reviews and meta-analyses.
Figure 2.
Figure 2.
(a) Time for NWB status. (b) Time to active ROM. (c) Time to full active ROM. (d) Time to elbow strengthening. (e) Time to no restrictions. (f) Time to HEP, with handout. (g) Time to start throwing program. Orange, operative; blue, nonoperative. HEP, home exercise program; NWB, nonweightbearing; ROM, range of motion.
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