Improved Repair Method for Ulnar Collateral Ligament in the Elbow

Ulnar collateral ligament (UCL) injuries can end the career of a throwing athlete. Many surgical approaches have been studied to reconstruct this ligament. The results of most methods are unable to give the patient the strength of the normal, uninjured ligament.

In this study, two orthopedic surgeons modified two of the methods in common use. One method was the docking technique. The two ends of the tissue graft used to replace the torn UCL are pushed or docked into one tunnel made through the bone.

The second technique used was the interference screw fixation method. Once the graft was threaded through the tunnel, a special screw was used to hold the graft in place. Combining these two methods, they developed a hybrid approach called the DANE TJ technique.

DA are the initials of the surgeon who developed the docking method. The second two initials (NE) stand for the surgeon who used the interference screw fixation method in UCL reconstruction. TJ stands for the first baseball player who had the first UCL reconstruction ever done in 1986.

There are several possible advantages of the DANE TJ technique. Using a single tunnel (instead of two tunnels often used in other methods) helps restore the anatomy more like the original design. With only one drill hole, there is less risk of bone fracture and nerve injury. A single tunnel is helpful when there isn't enough bone to form a bone bridge between two tunnels.

Results of the DANE TJ method were excellent for 19 out of 22 patients in this study. Two patients needed a second (revision) operation but had excellent outcomes in the end. Results were equal to (if not better) than those reported in studies using other methods of UCL repair.

The authors conclude the DANE TJ method is a good choice when there is poor bone stock to work with. It is also useful when the patient needs revision surgery to a previous injury that failed.

References: Joshua S. Dines, MD, et al. Clinical Outcomes of the Dane TJ Technique to Treat Ulnar Collateral Ligament Insufficiency of the Elbow. In The American Journal of Sports Medicine. December 2007. Vol. 35. No. 12. Pp. 2039-2044.