Essential Surgical Techniques
Surgical Technique: Medial Ulnar Collateral Ligament Reconstruction Using Hamstring Allograft
James A. Hurt III, MD; Felix H. Savoie III, MD; Michael J. O’Brien, MD


Introduction 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.

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

Indications …

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