Surgical Technique: Medial Ulnar Collateral Ligament Reconstruction Using Hamstring Allograft

[Introduction][1] In the overhead throwing athlete, medial ulnar collateral ligament reconstruction utilizing a hamstring allograft as an alternative to an autograft provides similar results without the donor site morbidity or potential complications of autograft harvest. [Step 1: MRI or MRA and Preoperative Planning][2] Obtain an MRI or MRA to determine the location and importance of the tear in the ligament. ![Figure][3] [Step 2: Medial Elbow Dissection and Identification of the Medial Ulnar Collateral Ligament][4] Position the elbow to allow access to the medial side, and expose the medial ulnar collateral ligament via a flexor-pronator split approach. ![Figure][3] [Step 3: Preparation of Hamstring Allograft][5] Prepare the non-irradiated hamstring allograft by placing lead Krackow stitches into each end, and if necessary suture it in the middle to help with passage through the bone tunnels. [Step 4: Ulnar-Sided Reconstruction][6] Use a single-hole technique, inserting a Beath pin into the sublime tubercle to allow a single screw to fix the graft into the ulna, OR use a double-hole technique, making connecting drill holes under the sublime tubercle and passing the graft through the tunnels. ![Figure][3] [Step 5: Humeral-Sided Reconstruction][7] Place a single drill hole into the center of the origin of the medial ulnar collateral ligament at the distal end of the medial epicondyle; place two connecting tunnels and shuttle the graft ends through these tunnels. ![Figure][3] [Step 6: Graft Fixation and Ligament Repair][8] Tension the graft while the elbow is placed though a full arc of motion, suture the two limbs of the graft together, and suture the medial ulnar collateral ligament to the graft. ![Figure][3] [Step 7: Closure][9] Irrigate the wound, repair the flexor-pronator fascia with absorbable suture, and perform a standard subcutaneous and skin closure. [Results][10] Medial ulnar collateral ligament reconstruction utilizing a hamstring allograft instead of an autograft has so far produced excellent results. [Indications][11] [Contraindications][12] [Pitfalls & Challenges][13] [Introduction][1] In the overhead throwing athlete, medial ulnar collateral ligament reconstruction utilizing a hamstring allograft as an alternative to an autograft provides similar results without the donor site morbidity or potential complications of autograft harvest. [Step 1: MRI or MRA and Preoperative Planning][2] Obtain an MRI or MRA to determine the location and importance of the tear in the ligament. ![Figure][3] [Step 2: Medial Elbow Dissection and Identification of the Medial Ulnar Collateral Ligament][4] Position the elbow to allow access to the medial side, and expose the medial ulnar collateral ligament via a flexor-pronator split approach. ![Figure][3] [Step 3: Preparation of Hamstring Allograft][5] Prepare the non-irradiated hamstring allograft by placing lead Krackow stitches into each end, and if necessary suture it in the middle to help with passage through the bone tunnels. [Step 4: Ulnar-Sided Reconstruction][6] Use a single-hole technique, inserting a Beath pin into the sublime tubercle to allow a single screw to fix the graft into the ulna, OR use a double-hole technique, making connecting drill holes under the sublime tubercle and passing the graft through the tunnels. ![Figure][3] [Step 5: Humeral-Sided Reconstruction][7] Place a single drill hole into the center of the origin of the medial ulnar collateral ligament at the distal end of the medial epicondyle; place two connecting tunnels and shuttle the graft ends through these tunnels. ![Figure][3] [Step 6: Graft Fixation and Ligament Repair][8] Tension the graft while the elbow is placed though a full arc of motion, suture the two limbs of the graft together, and suture the medial ulnar collateral ligament to the graft. ![Figure][3] [Step 7: Closure][9] Irrigate the wound, repair the flexor-pronator fascia with absorbable suture, and perform a standard subcutaneous and skin closure. [Results][10] Medial ulnar collateral ligament reconstruction utilizing a hamstring allograft instead of an autograft has so far produced excellent results. [Indications][11] [Contraindications][12] [Pitfalls & Challenges][13] [1]: #sec-10 [2]: #sec-11 [3]: pending:yes [4]: #sec-12 [5]: #sec-13 [6]: #sec-14 [7]: #sec-15 [8]: #sec-16 [9]: #sec-17 [10]: #sec-18 [11]: #sec-20 [12]: #sec-21 [13]: #sec-22