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.
Pitfalls & Challenges