Surgical Technique: Medial Ulnar Collateral Ligament Reconstruction Using Hamstring Allograft

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.

Obtain an MRI or MRA to determine the location and importance of the tear in the ligament.

Position the elbow to allow access to the medial side, and expose the medial ulnar collateral ligament via a flexor-pronator split approach.

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.

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.

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.

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.

Irrigate the wound, repair the flexor-pronator fascia with absorbable suture, and perform a standard subcutaneous and skin closure.

Medial ulnar collateral ligament reconstruction utilizing a hamstring allograft instead of an autograft has so far produced excellent results.IndicationsContraindicationsPitfalls & Challenges.