A Muscle-Splitting Approach to the Ulnar Collateral Ligament of the Elbow

Abstract

The standard surgical approach for repair or reconstruction of the ulnar collateral ligament of the elbow involves lifting off of the tendon of the common flexor bundle at its origin on the medial epicondyle. However, a more limited muscle-splitting approach may be feasible. A muscle-splitting approach is less traumatic to the flexor-pronator muscle mass, and it could decrease operative time and lessen immediate morbidity after surgery. A proposed muscle-split through the common flexor bundle extends from the medial humeral epicondyle to a point distal to the tubercle of the ulna such that repair or reconstruction can be performed on the ulnar collateral ligament. To examine the feasibility of this approach, we performed a study combining anatomic dissections with clinical observations. We dissected 15 fresh-frozen adult cadaveric elbows to examine the neuroanatomy of the medial side of the elbow. All pertinent nerves were identified and mapped. From these data, we defined a "safe zone" for a muscle-splitting approach to the ulnar collateral ligament that allows adequate room for repair or reconstruction of the ligament without risking denervation of the surrounding musculature. The safe zone extends from the medial humeral epicondyle to approximately 1 cm distal to the insertion of the ulnar collateral ligament on the tubercle of the ulna. Twenty-two patients with ulnar collateral ligament tears underwent either a direct repair or a reconstruction of the ligament using the proposed muscle-splitting approach. With a minimum followup of 1 year, there was no clinical evidence of muscle denervation. From the combined anatomic study and clinical data, we believe that a less traumatic muscle-splitting approach to the ulnar collateral ligament affords a safe and simple surgical approach for repair or reconstruction of the ligament.

Pitcher’s elbow: medial elbow pain in the overhead-throwing athlete

“…The same review identified several advancements in the original technique that appear to be associated with improved rate of return to prior level of play and decreased complication rate. One of the most significant modifications is the development of the muscle splitting technique as described by Smith et al [31] The original description of this technique was accompanied by a 0 % ulnar neuropathy rate in their series of 22 patients at 1-year follow-up.…”

Ligamentous reconstruction around the elbow using triceps tendon

“…A standard release is not performed routinely. A longitudinal split is made in the flexor carpi ulnaris (Smith et al 1996). The sublime tubercle at the proximal ulna and the medial epicondyle of the humerus are completely exposed.…”

Avulsion fracture of the sublime tubercle of the ulna: a newly recognized injury in the throwing athlete.

“…The sublime tubercle of the ulna is a small protuberance on the medial aspect of the cornnoid process of the ulna onto which the anterior band of the medial collateral ligament inserts [3]. In this report we describe three throwing athletes with avulsion injuries of the sublime tubercle of the ulna whose injuries were diagnosed with a combination of MR arthrography and plain radiography.…”

“…3-mm section with 1-mm interslice gap, and 16-cm field of view) were acquired using a 5-inch (12.7-cm) general purpose coil. Two of the patients had surgical exploration of the medial elbow joint.…”