Ulnar Collateral Ligament (UCL) Injuries: Repair With Anchors and Suture Augmentation

Ulnar Collateral Ligament (UCL) Injuries: Repair With Anchors and Suture Augmentation

This video will demonstrate a medial ulnar collateral ligament repair, or MUCL repair, of the elbow. In this demonstration, 2 types of sutures will be used. The first smaller suture will be used to repair the ligament, and the second, more prominent flat suture will provide additional support to the repair. Two bone anchors will hold the suture to the bone.

To review the pertinent anatomy, the MUCL lies on the medial or inner side of the elbow and connects the humerus to the ulna. Here is the inner side of the right elbow. The surgeon has already begun making a curved incision just overlying a bony prominence on the humerus called the medial epicondyle. The tissues under the skin are carefully dissected, mindful of important nerves and vessels.

The surgeon identifies 1 important nerve in this area: the ulnar nerve. The surgeon will protect this nerve throughout the surgery. Next to the nerve, the surgeon dissects tissue to expose the medial ulnar collateral ligament. This patient has a small lengthwise tear in the ligament. Under the tear, the surgeon inspects the joint line between the ulna and humerus, which in this patient, appears normal.

A hole has already been drilled into the ulna in preparation for the first bone anchor. Here, the surgeon holds the bone anchor on a handle with the 2 sutures attached. The anchor is screwed into the bone. Once securely in the bone, the 2 types of sutures are shown. Again, the small suture will repair the tear, and the more prominent suture will support the repair.

The surgeon is shown repairing the tear in the ligament by placing several small stitches side by side. The hole in the humerus bone will then be drilled for the final incoming bone anchor, which will hold the support suture in place. The surgeon is then shown capturing the flat support suture in the bone anchor.

Before entirely screwing the anchor and suture in place, the surgeon will bend the elbow to ensure that the support suture has just enough tension, not too tight or too loose, so that the elbow range of motion is preserved. Once happy with the tension, the surgeon will screw the anchor into the bone. Both the repair and the suture support are shown.

The remaining ends of the suture are trimmed, all while protecting the nearby ulnar nerve. The incision will be sutured closed, and the patient will be placed into a temporary splint. The surgery is now complete.