Background: A NCAA division I baseball pitcher at a university in the western U.S. underwent two UCL reconstruction procedures over the course of approximately two years. Overhead athletes are undergoing UCL reconstruction at an increased rate. Due to the increased frequency of this procedure, the number of patients who experience complications, such as graft failure, have increased. What is not known in many instances is what causes the graft to fail. Improper rehabilitation, throwing mechanics, and workload, among other factors, could contribute to graft failure and the need for a revision procedure. Analysis was done to account for the factors that led to graft failure in this individual case.

Objective: To analyze the variables associated with the athlete’s initial UCL reconstruction procedure, rehabilitation and activity versus those of the revision reconstruction and return to play progression to determine why graft failure occurred and what could have been done to prevent the failure.

Methods: Review of surgical notes, rehabilitation notes, and patient interview and observation. Review of current literature using EBSCOhost, CINAHL Plus, Cochrane, PubMed, and Medline. Keywords: UCL injury; UCL reconstruction; revision; rehabilitation; risk factors; overhead throwing; pitching.

Results: A number of factors have the potential to influence and increase the likelihood of UCL injury to baseball players of all ages and levels of competition. Overuse, biomechanical adaptation, and a glenohumeral internal rotation deficit were identified as causative factors leading to acute UCL rupture and secondary graft failure of this division I collegiate baseball pitcher. This report highlights a number of potential UCL injury risk factors for the overhead thrower that can be identified by the medical professional in hopes of preventing and decreasing the trend of UCL tears and subsequent revision procedures.