Comparison of a Novel Anatomic Technique and the Docking Technique for Medial Ulnar Collateral Ligament Reconstruction

Meyers, Kathleen N.; Middleton, Kellie K.; Fu, Michael C.; Dines, Joshua S.

doi:10.1177/03635465221076149

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…We believe that the various medial elbow anatomical descriptions and variations demonstrate the importance of characterizing the morphology of the sublime tubercle since this osseous landmark is frequently discussed and referenced. This relationship is vital to UCL reconstruction techniques which anchor the grafts around the sublime tubercle ( 18 , 19 ). Multiple studies have examined the medial elbow anatomy, but to our knowledge none have specifically examined the osseous morphology of the sublime tubercle in anterior-to-posterior plane described in this study ( 8 , 11 , 13 - 17 ).…”

Section: Discussionmentioning

confidence: 99%

Morphologic analysis of the sublime tubercle: considerations in the approach to ulnar collateral ligament reconstruction

Phillips¹,

Martín²,

Ford³

et al. 2022

Ann Joint

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Background Given the increased incidence of ulnar collateral ligament (UCL) injuries and the projected increase in reconstruction procedures, a robust understanding of the morphologic location of the sublime tubercle is paramount to anatomic reconstruction. There is limited research evaluating the morphology of the sublime tubercle of the proximal ulna in an anterior-to-posterior plane. Methods Twenty-five computed tomography (CT) scans of intact proximal elbow joints for patients were selected using a de-identified database. Cases with history of fracture or surgical intervention to the elbow joint were excluded. These CT scans were then imported into the Mimics Innovation Suite 24.0 software to analyze the sublime tubercle angle from the midpoint of the trochlear notch. All left elbow angle and clock-face values were converted to right elbow values for analysis. Results The average sublime tubercle angle from the midpoint of the trochlear notch was 282.53 degrees. The angle was converted to a clock face descriptor which located the sublime tubercle at 9.42. Our findings demonstrate that, in the non-throwing population, the morphology of the sublime tubercle can be expected to have a consistent medial location between 9 and 10 o’clock or 2 and 3 o’clock on the contralateral elbow. Conclusions In relation to the proximal ulnar landmarks, the sublime tubercle, in the non-throwing population, has a consistent relative location.

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Section: Discussionmentioning

confidence: 99%

Morphologic analysis of the sublime tubercle: considerations in the approach to ulnar collateral ligament reconstruction

Phillips¹,

Martín²,

Ford³

et al. 2022

Ann Joint

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“…2,4,5,8 A number of different surgical techniques have been developed in the past; however, most of these do not anatomically restore the native MUCL anatomy. 1,3,6,7 In recent years, we described an anatomic MUCL reconstruction technique that was designed to try to mimic the anatomy of the native ligament, and in biomechanical…”

Section: Video Transcriptmentioning

confidence: 99%

“…2,4,5,8 A number of different surgical techniques have been developed in the past; however, most of these do not anatomically restore the native MUCL anatomy. 1,3,6,7…”

Section: Video Transcriptmentioning

confidence: 99%

“…In recent years, we described an anatomic MUCL reconstruction technique that was designed to try to mimic the anatomy of the native ligament, and in biomechanical testing, this proved to have improved biomechanical strength compared to the docking technique. 1,7 This technique also allows for concomitant repair of the native MUCL under the graft, and a suture tape or internal brace can easily be added to improve the overall biomechanic strength. In this presentation, we will demonstrate the anatomic reconstruction of the MUCL with internal bracing and provide outcomes for both amateur and professional throwers.…”

Section: Video Transcriptmentioning

confidence: 99%

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Anatomic Medial Ulnar Collateral Ligament Reconstruction With Internal Brace Augmentation in Throwing Athletes

Camp,

Jurgensmeier,

Boos

et al. 2024

Video Journal of Sports Medicine

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Background: Injury to the medial ulnar collateral ligament (MUCL) is a common setback experienced by many throwing athletes often requiring reconstruction with 12 to 18 months of rehabilitation. Current reconstructive techniques fail to anatomically restore the MUCL. This presentation demonstrates the “anatomic technique” for reconstruction of the MUCL supplemented by internal brace augmentation. Indications: Initial injuries of the MUCL can often be managed conservatively; however, many complete tears and those failing nonoperative management are frequently treated with MUCL reconstruction. Technique Description: After graft harvest, a 6-cm incision is created over the medial epicondyle to expose the sublime tubercle and medial epicondyle. Sutures are placed through the torn ligament which are used to formally repair the native ligament. A 4-mm socket is drilled in the MUCL origin of the medial epicondyle, and two 2-mm penetrating sockets are drilled toward the base of the 4-mm socket. The sutures in the native ligament are passed through the sockets and later tied over the bone bridge to complete the native ligament repair. A tight rope is shuttled through the medial epicondyle socket and assembled. The palmaris longus autograft and a suture tape are loaded onto the tightrope and reduced into the humeral socket. On the ulna, soft suture anchors are placed on either side of the sublime tubercle. The distal end of the graft is then sutured utilizing a FiberWire. The graft is secured to the sublime tubercle by tying down the previously placed suture anchors. The suture tapes and internal brace are loaded into a SwiveLock suture anchor, which is fixed distally along the sublime tubercle ridge creating an anatomic reconstruction. Then, the native ligament sutures and tight rope are re-tensioned and tied across the humeral bone bridge for final fixation. Results: In our cohort of 26 professional and amateur throwers, >90% returned to play at the same level at a mean of 9.9 months postoperatively. Discussion/Conclusion: Anatomic reconstruction of the MUCL with internal bracing is a viable option for MUCL injuries and may allow expedited return to sport for most athletes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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2022 Bernard Morrey Award: the elbow ulnar collateral ligament complex demonstrates region specific stretching and recovery characteristics with valgus loading

Kwak

Nakla

Chung

et al. 2023

Journal of Shoulder and Elbow Surgery

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Comparison of a Novel Anatomic Technique and the Docking Technique for Medial Ulnar Collateral Ligament Reconstruction

Cited by 5 publications

References 22 publications

Morphologic analysis of the sublime tubercle: considerations in the approach to ulnar collateral ligament reconstruction

Morphologic analysis of the sublime tubercle: considerations in the approach to ulnar collateral ligament reconstruction

Anatomic Medial Ulnar Collateral Ligament Reconstruction With Internal Brace Augmentation in Throwing Athletes

2022 Bernard Morrey Award: the elbow ulnar collateral ligament complex demonstrates region specific stretching and recovery characteristics with valgus loading

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