James A Hurt1, Felix H Savoie1, Michael J O'Brien1. 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.
Abstract
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.IndicationsContraindicationsPitfalls & Challenges.
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.IndicationsContraindicationsPitfalls & Challenges.
Authors: E Lyle Cain; James R Andrews; Jeffrey R Dugas; Kevin E Wilk; Christopher S McMichael; James C Walter; Reneé S Riley; Scott T Arthur Journal: Am J Sports Med Date: 2010-10-07 Impact factor: 6.202