Management of Medial Collateral Ligament Tears in the Athlete

Medial collateral ligament insufficiency of the elbow can be a debilitating injury that often prevents athletes from competing effectively. The overhead athlete is particularly susceptible to this injury because the anterior bundle of the medial collateral ligament is the primary restraint to the valgus stress that is created during the throwing motion. Repetitive trauma from constant overhead or throwing activity can ultimately render the ligament incompetent and cause recurrent pain and instability. We have found that the only reliable way to return these athletes to sport is by ligament reconstruction. We currently use a “docking technique” that provides excellent graft fixation, the identification and treatment of intra-articular pathology, and the reduction of ulnar nerve related complications. This article details the assessment of the throwing athlete with valgus instability secondary to medial collateral ligament insufficiency and highlights the technical aspects for reconstruction.