Medial Collateral Ligament Reconstruction

In 1974, Frank Jobe first performed a medial collateral ligament (MCL) reconstruction on professional baseball pitcher Tommy John. Since that time, modifications to the surgical method have evolved to simplify the procedure, reduce complications, and improve results. The MCL is the primary restraint to valgus stress at the elbow. Biomechanically, the native MCL is underpowered to withstand the loads applied to it during high-level overhead athletic activities, such as pitching. The flexor carpi ulnaris muscle and the bony articulation of the elbow assist the MCL as secondary restraints. Nonetheless, injuries to the ligament are fairly frequent in elite as well as college level overhead athletes. Diagnosing MCL injuries depends on an adequate history, physical examination, and supplementary imaging modalities such as x-rays and magnetic resonance imaging. In athletes who wish to return to their previous level of competition, surgical reconstruction is indicated. Modifications to the original Jobe technique have been made that share 3 common tenets: a muscle splitting approach, careful handling of the ulnar nerve, and avoidance of posterior humeral bone tunnels. Three techniques that are described in this manuscript are the modified Jobe technique, the “docking” technique, and the hybrid or DANE TJ technique.

Keywords: medial collateral ligament reconstruction, valgus elbow instability, overhead athlete, Tommy John surgery