Anatomic Ulnar Collateral Ligament Repair With Internal Brace and Palmaris Longus Graft Using a Suture Bridge Construct

Background

Ulnar collateral ligament (UCL) and lateral collateral ligament (LCL) injuries of the elbow are common in athletes, particularly those involved in overhead sports. Traditional repair techniques may not always provide optimal long-term outcomes, necessitating the development of advanced reconstruction methods. Over the years, techniques such as the Modified Jobe and Docking Methods have been refined to improve graft fixation and reduce complications. Emerging strategies, such as suture augmentation and internal bracing, have demonstrated potential to enhance biomechanical stability and facilitate early rehabilitation. Indications: UCL/LCL reconstruction techniques, including those that utilize joint-spanning and/or internal brace augmentation, are indicated in cases where joint instability and dysfunction cannot be adequately addressed via traditional reconstruction or primary ligament repair alone. Technique Description: In the first step, the native UCL is repaired with a running, locking 2-0 FiberWire suture and reinforced with a spanning-suture bridge using linked, knotless suture anchors integrated into a spanning-suture construct. Next, the UCL reconstruction is performed using palmaris longus autograft passed through ulnar tunnels and docked into a humeral socket, with final graft tensioning to complete the reconstruction.