Comparison of Ulnar Collateral Ligament Reconstruction Techniques in the Elbow of Sports Players

Abstract

Ulnar collateral ligament injuries have been increasingly common in overhead throwing athletes. Ulnar collateral ligament reconstruction is the current gold standard for managing ulnar collateral ligament insufficiency, and numerous reconstruction techniques have been described. Although good clinical outcomes have been reported regarding return to sports, there are still several technical issues including exposure, graft selection and fixation, and ulnar nerve management. This review article summarizes a variety of surgical techniques of ulnar collateral ligament reconstructions and compares clinical outcomes and biomechanics.

Mechanical properties and microstructural organization of common ulnar collateral ligament grafts: Palmaris longus and gracilis tendons

“…A linear configuration used in the DANE‐TJ technique is similar to the docking technique, but utilizes an interference screw to secure the graft to the ulnar head. With this much variation in graft configurations, the mechanical and microstructural properties of the graft tissue itself are useful in parsing out the optimal surgical technique 24 . The revision rate of UCLRs is relatively low, and most revision surgeries are performed for osteophyte excisions.…”

“…With this much variation in graft configurations, the mechanical and microstructural properties of the graft tissue itself are useful in parsing out the optimal surgical technique. 24 The revision rate of UCLRs is relatively low, and most revision surgeries are performed for osteophyte excisions. In elbows with native UCLs, osteophyte formation has been linked to increased pressure on the posterior ulnar head from UCL insufficiency.…”

Trends in Elbow Ulnar Collateral Ligament Repairs and Reconstructions and an Analysis Between Low- and High-Volume Surgical Centers: A 10-Year Study in New York State

“…Modern techniques using more advanced suture anchor and biological suture augmentation technology have made repair a more appealing procedure, reducing operative time and surgical morbidity compared with reconstructions, as the surgical exposure required is reduced and the need for autograft harvest is obviated. 22 A secondary benefit of UCL repair over UCLR is the shortened time to return to sports, as many players return around 6 to 7 months after a repair compared with 12 to 18 months after UCLR. 1 , 9 …”

“…Modern techniques using more advanced suture anchor and biological suture augmentation technology have made repair a more appealing procedure, reducing operative time and surgical morbidity compared with reconstructions, as the surgical exposure required is reduced and the need for autograft harvest is obviated. 22 A secondary benefit of UCL repair over UCLR is the shortened time to return to sports, as many players return around 6 to 7 months after a repair compared with 12 to 18 months after UCLR. 1,9 We were surprised by our finding of high rates of ulnar nerve-related procedures with UCL repair compared with reconstruction techniques, as the more proximal exposure required around the medial epicondyle for the majority of reconstruction techniques lends itself to identifying, releasing, and/or transposing the ulnar nerve.…”