What is the UCL (ulnar collateral ligament)?
The ulnar collateral ligament in the elbow is a critical structure that keeps the elbow stable. It is located on the inside of the elbow (medial side, next to the body) and connects the ulna (one of the forearm bones) to the humerus (upper arm bone.) It’s job is to stabilize the elbow, keeping the firm connection of upper arm bone and forearm secure. The UCL can stretch with overuse and in some cases, tear either partially or completely. In these instances, it is no longer able to hold the bones tightly together.
What is done during an ulnar collateral ligament repair?
UCL repair, or Tommy John surgery is designed to restore stability to the elbow, allowing patients to return to athletic and daily activities without elbow pain. The procedure is typically done through open surgery, with an incision on the inside (medial area) of the elbow. Dr. Mazzara will reconstruct the ulnar collateral ligament by replacing it with a tendon graft from somewhere else in the body, usually the forearm, knee, foot or hamstring. This is called an autograft. The old ligament is left in place with the new ligament laid over the top of it.
The new tendon is attached by drilling holes in the two bones originally connected by the UCL: the humerus and the ulna. The graft tendon is threaded through the holes and secured by sutures and screws. There are several techniques of threading the new tendon through the bones; the figure-eight technique and the docking technique. The figure eight technique is what Dr. Jobe originally pioneered, where the graft is weaved through the tunnels of the bone and sutured into place. The docking technique reconstructs the UCL by looping a single continuous graft through the ulna bone tunnels and “docking” the sutured graft ends through the two humeral tunnels. The two ends of the graft are sutured together with a non-absorbable material over a bone bridge.