Ulnar Collateral Ligament Reconstruction: Docking Technique

Abstract

Prior to Jobe’s description of a reconstruction technique for ulnar collateral ligament (UCL) insufficiency, the injury was career ending. Despite successful results in about 70% of cases, concerns with elevation of the flexor-pronator mass, ulnar nerve complications, and relatively large bone tunnels in the medial epicondyle of the humerus led to modifications to Jobe’s technique. One of the most novel modifications was the “docking technique.” Differences included (1) arthroscopic evaluation and management, when indicated, of concomitant intra-articular pathology, (2) maintenance of the ulnar nerve in situ unless symptoms specifically indicate transposition, (3) use of a muscle splitting approach through the flexor mass, and (4) “docking” of the graft into a humeral socket. Ulnar preparation remained the same as the originally described Jobe. These modifications facilitated improved graft tensioning while minimizing the number of large tunnels drilled in the relatively small medial epicondyle. Intraoperative morbidity was minimized by the muscle-splitting approach and the reservation of ulnar nerve transposition only when indicated based on preoperative exam. Clinical results have been excellent using this technique, and it is our preferred technique for UCL reconstruction.