Medial Ulnar Collateral Ligament Tears: Surgical Indications and Reconstruction Technique

Injury to the medial collateral ligament (MCL) of the elbow is a debilitating condition in overhead throwing athletes, particularly baseball pitchers. In order to restore the primary ligamentous restraint against valgus stress at the elbow, MCL reconstruction is increasingly performed in both adolescent and elite throwing athletes in order to return to competition. We describe the pertinent surgical anatomy and indications for ligament reconstruction. Although various surgical techniques have been reported, we describe our preferred reconstruction with the docking technique through a muscle-splitting approach, which allows for secure graft fixation over bone bridges, identification and treatment of intra-articular pathology, and minimization of ulnar nerve-related complications. Excellent outcomes have been reported in approximately 90% of patients following MCL reconstruction with the docking technique.