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Double Docking Technique for Ulnar Collateral Ligament Reconstruction

March 01, 2017

Contributors: Mark S Cohen, MD; Brandon Erickson, MD; Anthony A Romeo, MD, FAAOS; Peter Nissen Chalmers, MD; Peter Nissen Chalmers, MD

The number of ulnar collateral ligament reconstruction procedures performed in the United States is steadily increasing. Since the Jobe technique for ulnar collateral ligament reconstruction was described in 1986, several modifications for ulnar collateral ligament reconstruction have been described. These modifications include various exposures, various fixation methods on the ulna and humerus, various graft options, concomitant elbow arthroscopy/ulnar nerve transposition, and other modifications. One modification is the double docking technique in which a single strand semitendinosus graft is docked on the ulna over a bone bridge and on the humerus with the use of a button. A pearl for the double docking ulnar collateral ligament reconstruction technique includes locating and preserving the branches of the medial antebrachial cutaneous nerve to prevent postoperative numbness and painful neuromas. In addition, ulnar nerve transposition is performed only if the patient has documented preoperative ulnar nerve symptoms. A bone bridge of less than 1 cm on the ulna increases the risk for breaking through the bone bridge postoperatively, and improper exposure and inadequate isolation of the ulnar nerve may lead to inadvertent injury. Finally, failure to properly expose the sublime tubercle or the medial epicondyle may lead to aberrant tunnel placement and nonphysiologic stress about the elbow. The double docking technique is a viable treatment option for patients who wish to undergo ulnar collateral ligament reconstruction for the management of a symptomatic, deficient ulnar collateral ligament.