UCL Reconstruction — (Palmaris Longus or Gracilis Graft)

Massachusetts General Hospital · MGH Sports Medicine

Weight-Bearing

No WB restrictions — UE protocol; hinged brace wks 1-6; posterior splint at 90 deg wk 1

Key Restrictions

Avoid valgus stress to elbow throughout; no shoulder ER isometrics Phase I; no ER strengthening until wk 6; no throwing until Phase V (wk 16+); gracilis graft: no hamstring strengthening until wk 6; D/C brace at wk 6 if full ROM achieved

Timeline & Phases

5 phases: Phase I (0-3 wks, posterior splint wk 1 at 90 deg; hinged brace wks 2-3 at 25-115 deg; isometrics shoulder/elbow; wrist AROM; elbow AROM begins day 14), Phase II (4-6 wks, brace extension progressed to full; wrist/forearm strengthening at 1 lb; biceps; scapular stabilization), Phase III (6-12 wks, no throwing; Thrower's 10 at wk 6; Advanced Thrower's 10 at wk 8; eccentric elbow F/E; 85% strength criteria), Phase IV (12-16 wks, 2-handed plyometrics at wk 12; 1-arm plyometrics; hitting program at wk 12), Phase V (16+ wks, interval throwing program; return to full sport)

Notes

Revised 6/2021; Tommy John surgery protocol; no throwing until 16+ wks; Thrower's 10 begins wk 6; throwing RTS criteria: ER/IR ratio 72-76%, ER/ABD ratio 68-73%, KJOC throwers score, physician clearance; gracilis graft adds knee ROM immediately post-op and bike at wk 3. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2026-07-30.]

Surgeon / Author

MGH Sports Medicine

Published

June 2021