Reconstruction of the Medial Collateral Ligament of the Elbow

Since Dr. Frank Jobe initially reported his first series for reconstruction of the medial collateral ligament (MCL) of the elbow in 1986,(1) many modifications have been developed to improve the strength, safety, and efficacy of the procedure.(2-7) High stresses occur across the anterior bundle of the MCL during the late cocking and early acceleration phases of throwing. Reported failures for reconstruction of the MCL have included stress fractures at the ulnar bone bridge or the distal humerus tunnels. In early techniques, graft placement was not anatomic, and it could not be tensioned appropriately in surgery. Hybrid modifications have arisen to improve patient outcomes and lessen patient morbidity.(4,5) We propose an alternative, hybrid technique using small bone tunnels in the medial epicondyle and a single, bioabsorbable screw in the ulna for anatomic reconstruction of both bundles of the MCL that can be tensioned before fixation. (J Hand Surg 2009;34A:1729-1733. Copyright (c) 2009 by the American Society for Surgery of the Hand. All rights reserved.)