What on Earth is an Internal Brace Procedure (What to Expect from Purdy this Season)
What is it an internal brace procedure?
An internal brace procedure is a type of surgical procedure used to fix a torn ulnar collateral ligament, or UCL. It is an alternative to Tommy John Surgery (TJS)
How does a UCL tear happen?
The UCL attaches from the lower humerus (arm bone) to the ulna (one of the forearm bones) and acts as a stabilizer of the inner elbow
When throwing an object, your shoulders muscles work hard to both accelerate and decelerate your arm. When your muscles don’t properly decelerate the arm, you can create more stress on the ligament and weakening it over time. Usually some small tearing will be seen before a full rupture occurs, either from contact (in Purdy’s case) or non contact in the case of a baseball player.
It’s thought that strength imbalances, throwing volume, velocity, fatigue, and muscle activation timing are risk factors for injury.
Prevalence of UCL injury was .4 for every 10,000 games or practices for football, compared to 1.12 for baseball
Tommy John Surgery (UCL reconstruction)
Traditionally this has been the surgery that has been performed. Similar to an ACL tear, a graft is taken, usually from a wrist muscle. Because of this, the beginning of rehab is significantly delayed due to a process called ligamentization. Ligamentization is the process of a non ligamentous structure (a tendon in this case) turning into a ligament. After the graft is attached the elbow, the graft weakens and dies before a new blood supply is taken, and it begins to strengthen.
One study looked at MLB players and rate of return to play (RTP) for TJS. Mean time to RTP was 11 months, with 85% of players returning to the same competition level or higher. This study was 94% baseball players, and there is essentially no studies on QBs.
Internal Brace
Instead of reconstructing the ligament, the procedure is a repair of the native ligament, and then an “internal brace” is used to supplement the repair. Because there is no need for ligamentization, we see quicker rehab times for this.
You might ask why everyone doesn’t do this procedure. The short answer is that it’s new, and we KNOW that TJS has good outcomes even if it takes a long time. It’s better in younger population (around 20 years old) and it’s only possible in the case of an avulsion injury.
One study looked at overhead athletes who had an internal brace procedure, and 92% of overhead athletes returned to the same or higher level of competition with a mean time between 6 and 7 months.
Conclusions for fantasy:
RTP rates for baseball players (who throw harder, higher quantity, and a smaller ball) are very good with both TJS and internal brace
Players with internal brace return typically within 6-7 months
Purdy is reportedly on time with his rehab, and began a throwing program 12 weeks after surgery (March 10)
Sept 10 will be exactly 6 months since surgery, which is the first game for the 49ers.