Ulnar Collateral Ligament Reconstruction of the Elbow With Double Suspensory Fixation

Autor: Kyle Schoell, Daniel C. Acevedo, Anshuman Singh, Raffy Mirzayan
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Arthroscopy Techniques, Vol 10, Iss 2, Pp e303-e309 (2021)
Arthroscopy Techniques
ISSN: 2212-6287
Popis: Ulnar collateral ligament reconstruction of the elbow has evolved substantially since its introduction in 1974. Numerous variations of the surgery have been introduced, including modifications in tunnel creation, graft tensioning, and fixation. These changes have aimed to improve overall quality of the reconstruction; however, even the most commonly used techniques still present many challenges. We describe a technique for ulnar collateral ligament (UCL) reconstruction using bisuspensory button fixation and a single tunnel on both the ulnar and humeral sides. This technique avoids many of the most common complications and methods of failure of UCL reconstruction, provides immediate strong graft fixation, and offers the surgeon a technically less demanding procedure.
Technique Video Video 1 The patient is placed in a supine position. The left forearm and elbow are exposed in this demonstration. The palmaris longus is harvested through stab incisions. The graft is doubled or tripled over an ACL TightRope RT button (Arthrex), and the toggling sutures are pulled, reducing the button to the graft. It is crucial that the toggling sutures are tied to each other so that the button stays in contact with the graft. A medial incision, based over the medial epicondyle, is used. The medial antebrachial cutaneous nerve is identified and protected. The ulnar nerve is not routinely transposed. The flexor carpi ulnaris fascia is incised in a muscle-splitting approach down to the ulnar collateral ligament, which is also incised in line with the fibers. The pronator muscle is elevated off the anterior surface of the medial epicondyle, and the origin of the ulnar collateral ligament on the medial epicondyle is identified and bluntly dissected. A 2.4-mm guide pin is inserted from the origin of the ulnar collateral ligament of the medial epicondyle and advanced until it exits the anterior surface of the medial epicondyle. A 4.5-mm cannulated reamer is then placed over the guide wire and reamed bicortically, exiting the anterior surface of the medial epicondyle. A 3.2-mm spade-tipped guide pin is placed just distal to the sublime tubercle with the initial trajectory aimed proximally to avoid skiving off the slope of the sublime tubercle, and then redirected 30° distally to exit away from the dorsal cortex. A 5.5-mm Low Profile reamer (Arthrex) is used to create a unicortical tunnel. The graft is passed in the humeral tunnel in a proximal to distal direction, taking care that the button is firmly in contact with the cortex and rotated so that it is perpendicular to the tunnel. The sutures from the ulnar end of the graft are then passed through a biceps button and loaded onto an inserter. The button is inserted and flipped on the far cortex of the ulnar tunnel. The suture limbs are then toggled to insert the graft into the ulnar tunnel with the elbow at 90°. An arthroscopic knot pusher is used to tie locking knots and advanced to the base of the tunnel to keep the graft reduced. The eyelet of a 4.75-mm BioComposite SwiveLock anchor (Arthrex) is removed, and one of the suture limbs is passed through the implant, which is advanced to achieve aperture fixation. The fascial incisions are then closed with #0 dissolvable sutures.
Databáze: OpenAIRE
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