UCL Treatment Failures and the Difference Between Surgical and Interventional Orthopedics
Last week an article was published in the LA Times about some high-profile failures of stem cell UCL treatment and the subsequent need for Tommy John surgery. I read the piece and chuckled a bit because I knew why these cases likely failed. Let me explain.
What Is the UCL?
The UCL is a ligament that lives on the inside of the elbow. It stabilizes the inside of the main elbow joint and gets a lot of pressure as pitchers whip the ball. Hence, it tends to get beat up and torn in that population of athletes. However, it gets injured in many others, including in those involved in weightlifting and other sports that use the arms and hands.
The Success of Stem Cells and PRP Is Always What+How+Where
Autologous orthobiologics, like stem cells and PRP, aren’t drugs; they are made from your body. Hence, you need to keep in mind three things that can be the difference between a treatment success and failure:
- What? The type of mix that’s injected can make a huge difference. Meaning, if it’s platelet-rich plasma, were red blood cells included (red PRP) or excluded (amber PRP)? What was the platelet concentration? If it’s stem cells, what type? At what concentration?
- How? Were the cells blindly injected? Were they instead injected, using ultrasound, precisely into the UCL? Was the physician ever trained in how to inject the UCL?
- Where? Did the PRP or stem cells ever make it into the tears in the ligament?
Of course, none of this is discussed by the sportswriter who penned this article. He doesn’t understand enough to know to ask these questions. To him, a stem cell is a stem cell is a stem cell. In addition, in these cases, an orthopedic surgeon performed these procedures, who would not have the training in interventional orthopedics to pull them off at a high level. Hence, in all likelihood, these athletes were hamstrung from the outset.
Surgical vs. Interventional Orthopedics
Why wouldn’t an orthopedic surgeon know how to inject a UCL? First, this procedure needs to be performed using ultrasound guidance. Ninety-nine percent of orthopedic surgeons aren’t trained to use this equipment to even identify where this ligament lives, let alone inject it precisely and find the small tears in the ligament. This instead is interventional orthopedics, meaning the use of precise image-guided injections. There is very real and very specialized training required, and the few orthopedic surgeons who I’ve taught have been some of the poorest students. Why? This isn’t what they do all day. Having said that, there are surgeons out there who have taken the time to learn this stuff, but they are, right now, few and far between. Check out my video below on the subject:
An Example of a Successful UCL Treatment
This is the case of a 25-year-old female Olympic lifter and occupational therapy student who had a high-grade partial UCL tear. She went to an orthopedic surgeon who told her that she needed Tommy John surgery, but she told him she wanted to try other options first to get the ligament to heal on its own. Despite the surgeon not having a clue how to inject the ligament properly, he told the patient that if we or anyone else tried to inject it, we may injure her ulnar nerve. That, of course, wasn’t true in our experienced hands, but we see scare tactics used by surgeons to sell procedures all day, so we took it in stride.
Dr. Markle at our Colorado HQ precisely injected high-dose amber PRP into the ligament using exacting ultrasound guidance in April. She was braced for four weeks, and Dr. Markle followed up with her at three months, in July, when she reported being 90% improved. At that point, she began PT to regain a small amount of lost mobility.
The upshot? Remember that all PRP and stem cell treatments are vastly different, especially in the quality of what’s injected, how it’s injected, and where it ends up. Hence, ignore sportswriters who don’t know what they don’t know. Real interventional orthopedic treatments of most UCL injuries are here to stay; they just won’t be done by poorly trained orthopedic surgeons but, rather, by highly trained physician specialists who know the importance of What+How+Where.