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. 2012 Sep;4(5):433-7.
doi: 10.1177/1941738112454649.

Ulnar collateral ligament reconstruction revisited: the procedure I use and why

Christopher C Dodson  1 , David W Altchek
Affiliations

Ulnar collateral ligament reconstruction revisited: the procedure I use and why

Christopher C Dodson et al. Sports Health. 2012 Sep.

Abstract

Context: Ulnar collateral ligament (UCL) insufficiency of the elbow can be a debilitating injury that often prevents athletes from competing effectively. The overhead athlete is particularly susceptible to this injury because the anterior bundle of the UCL is the primary restraint to the valgus stress that is created during the throwing motion. Repetitive trauma from constant overhead or throwing activity can ultimately render the ligament incompetent and cause recurrent pain and instability.

Results: The authors currently use a "docking" technique that provides excellent graft fixation and reduces ulnar nerve related complications.

Conclusions: This article details the assessment of the throwing athlete with valgus instability secondary to UCL insufficiency and highlights the technical aspects for reconstruction. The majority of athletes who undergo UCL reconstruction of the elbow can successfully return to their preinjury function. STRENGTH-OF-RECOMMENDATION TAXONOMY (SORT): A.

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Figures

Figure 1.
Figure 1.
When present, the palmaris longus is harvested for graft reconstruction. The visible portion of the tendon is tagged with a suture.
Figure 2.
Figure 2.
A tendon stripper is used to harvest the remaining tendon once it has been identified and tagged.
Figure 3.
Figure 3.
Final picture demonstrating complete harvest of the Palmaris tendon.
Figure 4.
Figure 4.
A muscle-splitting approach is utilized through the posterior one third of the common flexor pronator mass within the most anterior fibers of the flexor carpi ulnaris muscle (dotted line).
Figure 5.
Figure 5.
The sublime tubercle is exposed subperiosteally in preparation for drilling ulnar tunnels.
Figure 6.
Figure 6.
The graft is passed through the ulnar tunnel anterior to posterior. The limb with sutures is ultimately docked into the humerus.
Figure 7.
Figure 7.
Final length is determined by referencing the graft to the exit hole in the humeral tunnel. This point is marked on the graft, and a No. 1 Ethibond suture is placed in a Krackow fashion.
Figure 8.
Figure 8.
Once both limbs of the graft have been successfully docked into the humeral tunnel, the graft sutures are tied down.
Figure 9.
Figure 9.
Final photograph demonstrating the completed UCL reconstruction.
See this image and copyright information in PMC

References

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    1. Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74(1):67-83 - PubMed
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    1. Dodson CC, Thomas A, Dines JS, et al. Medial collateral ligament reconstruction of the elbow in throwing athletes. Am J Sports Med. 2006;34(12):1926-1932 - PubMed