Medial Collateral Ligament Reconstruction of the Elbow using the Docking Technique

Background: Medial collateral ligament insufficiency of the elbow with resultant valgus instability in throwing athletes is typically treated with free tendon graft reconstruction as described by Jobe. Hypothesis: Improved results could be obtained with the use of the docking technique. Study Design: Uncontrolled retrospective review. Methods: The study group consisted of 36 athletes who had symptomatic insufficiency of the medial collateral ligament confirmed by magnetic resonance imaging and by surgical findings. Average follow-up was 3.3 years. Key elements of the docking technique included a muscle-splitting approach without routine transposition of the ulnar nerve, routine arthroscopic assessment, treatment of associated lesions, and docking the two ends of the tendon graft into a single humeral tunnel. Results: Thirty-three of 36 patients (92%) returned to or exceeded their previous level of competition for at least 1 year, meeting the Conway-Jobe classification criteria of “excellent.” All 22 professional or collegiate athletes returned to or exceeded their previous competition level. Conclusions: The docking technique allowed simplified graft tensioning and improved graft fixation.