New Technique of Reconstruction for Medial Elbow Instability

Abstract

This study reports a new substitution technique as a choice to repair both acute and chronic injuries of the ulnar collateral ligament of the elbow. Different researchers have described different techniques to reconstruct the medial ligament complex with similar results (with the use of grafts). There is a shared variable in the latest reports, the interpretation of the anterior bundle as the most important structure, for medial elbow stability and the only structure to be repaired as well. The approach to the medial structures of the elbow is similar to most of the surgical techniques. It consists of an incision on the medial aspect of the elbow, centered on the epicondyle, of length 4 inches. The reconstruction uses a strip of the aponeurosis of the flexor carpi ulnaris (FCU) reinforced with Kracow stitches. The graft is harvested using the strong aponeurosis of the FCU, a vascularized structure, a viable option and with sufficient resistance to bear the tension of the inner aspect of the elbow. The surgical morbidity is also reduced as the graft is not taken from other zones. As the distal insertion of the neo-ligament, the proximal fixation of the FCU is used in the sublime tubercle, inverting the direction of the fibers of this strip from distal to proximal. The proximal fixation of this ligament is an osseous tunnel in the epitroclea secured with an interference screw. Common complications are those resulting from the approach and the ulnar nerve manipulation. Owing to the satisfactory stability outcome achieved by this technique, early rehabilitation may start without inconveniences.