Revision Ulnar Collateral Ligament Reconstruction

Jeremy R. Bruce, MD; Neal S. ElAttrache, MD; James R. Andrews, MD

Disclosures

J Am Acad Orthop Surg. 2018;26(11):377-385. 

In This Article

Senior Author's Preferred Revision Technique

Surgical planning is essential for successful revision UCL reconstruction. When no bone insufficiency or fracture is present, the senior author (J.R.A.) prefers to use a figure-of-8/ASMI technique. The previous incision is reused, and care is taken during ulnar nerve neurolysis and handling because the nerve is often scarred and adherent to surrounding tissues.

In most cases, the initial graft tissue is still present and hypertrophied, as the UCL graft and native UCL are scarred together in a thick mass. The graft often needs to be debulked to make new tunnels and pass a new graft. As in the primary procedure, a longitudinal incision is made through the original graft/UCL tissue to facilitate visualization of the joint line and sublime tubercle[2] and to orient the surgeon for tunnel drilling and preparation. The humeral tunnels are drilled similar to that for a primary procedure.[2] A new graft is passed, tensioned, and secured in figure-of-8 fashion. After graft passage, the original graft and UCL tissue is closed to allow for added collagen and healing to the overall revision UCL construct, similar to repair of a UCL in a primary procedure (Figure 5).

At the end of the procedure, it is important to let the tourniquet down prior to closure to obtain hemostasis and prevent hematoma and formation of adhesions, especially around the ulnar nerve. With revision surgery, the scar tissue can bleed excessively, and placement of a small Hemovac drain may help prevent hematoma formation.

Similar to rehabilitation after revision ACL reconstruction, a less aggressive postoperative protocol should be used after revision UCL reconstruction. Many aspects of rehabilitation are delayed after a revision procedure compared with a primary UCL reconstruction, including removal of the posterior splint (at 10 days versus 5 to 7 days postoperatively) and initiation of an interval throwing program (at 6 months versus 4 months; Table 1). Full recovery after revision UCL reconstruction compared with primary reconstruction is expected at 1.5 years versus 1 year.

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