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. 2012 Sep;4(5):438-41.
doi: 10.1177/1941738112455318.

The ulnar collateral ligament procedure revisited: the procedure we use

James R Andrews  1 , Patrick W Jost, E Lyle Cain
Affiliations

The ulnar collateral ligament procedure revisited: the procedure we use

James R Andrews et al. Sports Health. 2012 Sep.

Abstract

Context: The ulnar collateral ligament of the elbow (UCL) is frequently injured in throwing athletes, most commonly baseball pitchers. The ligament is reconstructed through bone tunnels using palmaris longus or gracilis autograft.

Results: This study highlights the following technique for UCL reconstruction in over 2000 athletes.(2)

Conclusion: When conservative management fails, ligament reconstruction can allow the athlete to return to their sport.(1).

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Figures

Figure 1.
Figure 1.
The Palmaris graft is confirmed at all 3 incision sites before it is cut distally, secured with a whipstitch, and delivered out of the proximal wound.
Figure 2.
Figure 2.
The medial antebrachial cutaneous nerve is usually found in the distal third of the exposure.
Figure 3.
Figure 3.
The ulnar nerve is dissected free from the cubital tunnel and mobilized with a vessel loop.
Figure 4.
Figure 4.
The flexor digitorum profundus muscle belly is elevated to expose the native ulnar collateral ligament, which is directly beneath the scalpel blade.
Figure 5.
Figure 5.
The ulnar collateral ligament is split longitudinally with a scalpel to expose its deep fibers as well as the ulnohumeral joint.
Figure 6.
Figure 6.
The ulnar tunnels are drilled on either side of the sublime tubercle, perpendicular to the joint surface.
Figure 7.
Figure 7.
The graft is passed through the ulnar tunnel.
Figure 8.
Figure 8.
The humeral tunnel is drilled from distal to proximal, starting at the native insertion of the ulnar collateral ligament onto the humerus.
Figure 9.
Figure 9.
A curette is placed in the first humeral tunnel while the second tunnel is drilled.
Figure 10.
Figure 10.
The graft is passed through the humeral tunnels.
Figure 11.
Figure 11.
The graft is sewn together between the humeral and ulnar tunnels to increase tension within the graft and re-create the course of the native ligament.
See this image and copyright information in PMC

References

    1. Aoki M, Takasaki H, Muraki T, et al. Strain on the ulnar nerve at the elbow and wrist during throwing motion. J Bone Joint Surg Am. 2005;87(11):2508-2514 - PubMed
    1. Cain EL, Andrews JR, Dugas JR, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426-2434 - PubMed
    1. Ciccotti MG, Jobe FW. Medial collateral ligament instability and ulnar neuritis in the athlete’s elbow. Instr Course Lect. 1999;48:383-391 - PubMed
    1. Dugas JR, Bilotta J, Watts CD, et al. Ulnar collateral ligament reconstruction with gracilis tendon in athletes with intraligamentous bony excision: technique and results [published online May 11, 2012]. Am J Sports Med. - PubMed
    1. Dugas JR, Ostrander RV, Cain EL, Kingsley D, Andrews JR. Anatomy of the anterior bundle of the ulnar collateral ligament. J Shoulder Elbow Surg. 2007;16(5):657-660 - PubMed