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Double Docking Technique for Ulnar Collateral Ligament Reconstruction

March 01, 2017

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

The number of ulnar collateral ligament reconstructions (UCLR) performed in the United States in steadily increasing. Since the description of the original Jobe technique in 1986, several modifications for performing UCLR have been described. These modifications include differences in exposure, fixation methods on the ulna and humerus, graft choice, concomitant elbow arthroscopy/ulnar nerve transposition, and others. 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 hummus using a button. A pearl for performing the double docking UCLR technique includes locating and preserving the branches of the medial antebrachial cutaneous nerve to prevent postoperative numbness and painful neuromas. Furthermore, ulnar nerve transposition is only performed if the patient has documented preoperative ulnar nerve symptoms. A bone bridge of less than one centimeter on the ulna places the patient at risk for breaking through the bone bridge postoperatively and improper exposure and inadequate isolation of the ulnar nerve can lead to inadvertent injury. Finally, failure to properly expose the sublime tubercle or medial epicondyle can lead to aberrant tunnel placement and non-physiologic stress about the elbow. The double docking technique is a viable option for patients who wish to undergo an ulnar collateral ligament reconstruction for a symptomatic, deficient ulnar collateral ligament.

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