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Surgical Technique: Medial Ulnar Collateral Ligament Reconstruction Using Hamstring Allograft
James A. Hurt, III, MD1; Felix H. Savoie, III, MD1; Michael J. O’Brien, MD1
1 Tulane University Department of Orthopaedic Surgery, 1430 Tulane Avenue SL-32, New Orleans, LA 70112. E-mail address for F.H. Savoie: fsavoie@tulane.edu
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Based on an original article: J Bone Joint Surg Am. 2013 Jun 19;95(12):1062-6.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Dec 11;3(4):e23 1-8. doi: 10.2106/JBJS.ST.M.00032
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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

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

Step 2: Medial Elbow Dissection and Identification of the Medial Ulnar Collateral Ligament

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

Step 3: Preparation of Hamstring Allograft

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

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.

Step 5: Humeral-Sided Reconstruction

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.

Step 6: Graft Fixation and Ligament Repair

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.

Step 7: Closure

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.



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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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