Skip to main content

Ulnar Collateral Ligament Reconstruction: Graft Selection and Harvest Technique

  • Chapter
  • First Online:
Elbow Ulnar Collateral Ligament Injury
  • 1502 Accesses

Abstract

Ulnar collateral ligament (UCL) reconstruction has demonstrated success at returning overhead athletes to a high level of function. The most common graft utilized for UCL reconstruction is the palmaris longus followed by the gracilis tendon. Graft selection is based on surgeon and patient preference, anatomic presence of a palmaris tendon, and ability to perform a safe tendon harvest with low morbidity. Strict attention to surgical technique reduces the risk of complications and provides the optimal graft size, length, and quality for a successful reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cain EL Jr, Andrews JR, Dugas JR, Wilk KE, McMichael CS, Walter JC 2nd, Riley RS, Arthur ST. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426–34.

    Article  PubMed  Google Scholar 

  2. Dodson CC, Thomas A, Dines JS, Nho SJ, Williams RJ 3rd, Altchek DW. Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes. Am J Sports Med. 2006;34(12):1926–32.

    Article  PubMed  Google Scholar 

  3. Azar FM, Andrews JR, Wilk KE, Groh D. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med. 2000;28(1):16–23.

    CAS  PubMed  Google Scholar 

  4. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am. 1986;68:1158–1163.

    CAS  PubMed  Google Scholar 

  5. Andrews JR, Jost PW, Cain EL. The ulnar collateral ligament procedure revisited: the procedure we use. Sports Health. 2012;4(5):438–41.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Smith GR, Altchek DW, Pagnani MJ, Keeley JR. A muscle-splitting approach to the ulnar collateral ligament of the elbow. Neuroanatomy and operative technique. Am J Sports Med. 1996;24(5):575–80.

    Article  CAS  PubMed  Google Scholar 

  7. Rohrbough JT, Altchek DW, Hyman J, Williams RJ 3rd, Botts JD. Medial collateral ligament reconstruction of the elbow using the docking technique. Am J Sports Med. 2002;30(4):541–48.

    PubMed  Google Scholar 

  8. Dodson CC, Altchek DW. Ulnar collateral ligament reconstruction revisited: the procedure I use and why. Sports Health. 2012;4(5):433–7.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med. 1983;11(5):315–9.

    Article  CAS  PubMed  Google Scholar 

  10. Fleisig GS, Escamilla RF. Biomechanics of the elbow in the throwing athlete. Oper Tech Sports Med. 1996;4(2):62–8.

    Article  Google Scholar 

  11. Werner SL, Fleisig GS, Dillman CJ, et al. Biomechanics of the elbow during baseball pitching. J Orthop Sports Phys Ther. 1993;17:274–8.

    Article  CAS  PubMed  Google Scholar 

  12. Prud’homme J, Budoff JE, Nguyen L, Hipp JA. Biomechanical analysis of medial collateral ligament reconstruction grafts of the elbow. Am J Sports Med. 2008 Apr;36(4):728–32.

    Article  PubMed  Google Scholar 

  13. Ahmad CS, Lee TQ, ElAttrache NS. Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation. Am J Sports Med. 2003;31:332–7.

    PubMed  Google Scholar 

  14. Paletta GA Jr, Klepps SJ, Difelice GS, et al. Biomechanical evaluation of 2 techniques for ulnar collateral ligament reconstruction of the elbow. Am J Sports Med. 2006;34:1599–1603.

    Article  PubMed  Google Scholar 

  15. Dines JS, Jones KJ, Kahlenberg C, Rosenbaum A, Osbahr DC, Altchek DW. Elbow ulnar collateral ligament reconstruction in javelin throwers at a minimum 2-year follow-up. Am J Sports Med. 2012;40(1):148–51.

    Article  PubMed  Google Scholar 

  16. Argo D, Trenhaile SW, Savoie FH 3rd, Field LD. Operative treatment of ulnar collateral ligament insufficiency of the elbow in female athletes. Am J Sports Med. 2006;34(3):431–7.

    Article  PubMed  Google Scholar 

  17. Troha F, Baibak GJ, Kelleher JC. Frequency of the palmaris longus tendon in North American Caucasians. Ann Plast Surg. 1990;25(6):477–8.

    Article  CAS  PubMed  Google Scholar 

  18. Soltani AM, Peric M, Francis CS, Nguyen TT, Chan LS, Ghiassi A, Stevanovic MV, Wong AK. The variation in the absence of the palmaris longus in a multiethnic population of the United States: an epidemiological study. Plast Surg Int. 2012;2012:282959.

    PubMed Central  PubMed  Google Scholar 

  19. Regan WD, Korinek SL, Morrey BF, An KN. Biomechanical study of ligaments around the elbow joint. Clin Orthop Relat Res. 1991;271:170–9.

    PubMed  Google Scholar 

  20. Armstrong AD, Dunning CE, Ferreira LM, Faber KJ, Johnson JA, King GJ. A biomechanical comparison of four reconstruction techniques for the medial collateral ligament–deficient elbow. J Shoulder Elbow Surg. 2005;14:207–15.

    Article  PubMed  Google Scholar 

  21. Jones KJ, Osbahr DC, Schrumpf MA, Dines JS, Altchek DW. Ulnar collateral ligament reconstruction in throwing athletes: a review of current concepts. AAOS exhibit selection. J Bone Joint Surg Am. 2012;94(8):e49.

    Article  PubMed  Google Scholar 

  22. Dugas JR, Bilotta J, Watts CD, Crum JA, Fleisig GS, McMichael CS, Cain EL Jr, Andrews JR. Ulnar collateral ligament reconstruction with gracilis tendon in athletes with intraligamentous bony excision: technique and results. Am J Sports Med. 2012;40(7):1578–82.

    Article  PubMed  Google Scholar 

  23. Shelton WR, Fagan BC. Autografts commonly used in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg. 2011;19(5):259–64. Review.

    PubMed  Google Scholar 

  24. Prodromos CC, Fu FH, Howell SM, Johnson DH, Lawhorn K. Controversies in soft-tissue anterior cruciate ligament reconstruction: grafts, bundles, tunnels, fixation, and harvest. J Am Acad Orthop Surg. 2008;16(7):376–84.

    PubMed  Google Scholar 

  25. Ardern CL, Webster KE, Taylor NF, Feller JA. Hamstring strength recovery after hamstring tendon harvest for anterior cruciate ligament reconstruction: a comparison between graft types. Arthroscopy. 2010;26(4):462–9.

    Article  PubMed  Google Scholar 

  26. Pagnani MJ, Warner JJ, O’Brien SJ, Warren RF. Anatomic considerations in harvesting the semitendinosus and gracilis tendons and a technique of harvest. Am J Sports Med. 1993;21(4):565–71.

    Article  CAS  PubMed  Google Scholar 

  27. Prodromos CC, Han YS, Keller BL, Bolyard RJ. Posterior mini-incision technique for hamstring anterior cruciate ligament reconstruction graft harvest. Arthroscopy. 2005;21(2):130–7.

    Article  PubMed  Google Scholar 

  28. Sanders B, Rolf R, McClelland W, Xerogeanes J. Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury. Arthroscopy. 2007;23(9):956–63.

    Article  PubMed  Google Scholar 

  29. Weber RV, Mackinnon SE. Median nerve mistaken for palmaris longus tendon: restoration of function with sensory nerve transfers. Hand (N Y). 2007;2(1):1–4.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to James E. Voos MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Voos, J. (2015). Ulnar Collateral Ligament Reconstruction: Graft Selection and Harvest Technique. In: Dines, J., Altchek, D. (eds) Elbow Ulnar Collateral Ligament Injury. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7540-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4899-7540-9_12

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4899-7539-3

  • Online ISBN: 978-1-4899-7540-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics