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. 2017 Dec 25;7(1):e53-e56.
doi: 10.1016/j.eats.2017.08.052. eCollection 2018 Jan.

Ulnar Collateral Ligament Repair With Suture Augmentation

David P Trofa  1 , Joseph M Lombardi  1 , Manish S Noticewala  1 , Christopher S Ahmad  1
Affiliations

Ulnar Collateral Ligament Repair With Suture Augmentation

David P Trofa et al. Arthrosc Tech. .

Abstract

Reconstruction of the ulnar collateral ligament (UCL) remains the gold standard for treating overhead throwing athletes with valgus instability secondary to UCL pathology. Although surgical techniques for reconstruction have evolved over time, current methods allow 90% of patients to return to their preinjury level of activity. Despite encouraging results with reconstruction, UCL repair remains a valuable treatment option for patients with UCL pathology fitting specific criteria. There are a number of advantages associated with a direct repair, and further, the development of collagen-coated sutures for ligament repair augmentation makes this procedure an attractive surgical option under the correct circumstances. This article provides a detailed description and video demonstration of the surgical steps used to perform a UCL repair with suture augmentation.

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Figures

Fig 1
Fig 1
The patient is placed in the supine position with the operative right extremity on a hand table. An 8- to 10-cm incision is marked over the medial elbow. The medial epicondyle (ME) is outlined.
Fig 2
Fig 2
Supine position, right elbow, illustrating the muscle-splitting approach. After superficial dissection, the FCU fascia is incised longitudinally from distal to proximal toward the medial epicondyle (ME) and the muscle is dissected bluntly (A). After blunt dissection is carried through the FCU muscle, the UCL is exposed from the sublime tubercle to the medial epicondyle (ME) (B). The native UCL is then incised in line with its fibers from the sublime tubercle (ST) to the medial epicondyle (ME), exposing the underlying ulnohumeral (UH) joint (C). (FCU, flexor carpi ulnaris; UCL, ulnar collateral ligament.)
Fig 3
Fig 3
Supine position, right elbow. Identification of the UCL insertion on the sublime tubercle (ST) to prepare a drill hole for a suture anchor loaded with collagen-coated tape and a size 0 high-tensile nonabsorbable repair suture. The medial epicondyle (ME) is labeled for orientation (A). Appearance of the UCL after distal repair and placement of 3 simple sutures from distal to proximal (B). The collagen-coated tape is placed through the eyelet of a second suture anchor that is placed into the isometric point of the ME (C). (UCL, ulnar collateral ligament.)
Fig 4
Fig 4
Supine position, right elbow. Final appearance of the UCL repair with suture augmentation. The sublime tubercle (ST) and medial epicondyle (ME) are labeled for orientation. (UCL, ulnar collateral ligament.)
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