Medial collateral ligament reconstruction of the elbow using the docking technique.

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. Improved results could be obtained with the use of the docking technique. Uncontrolled retrospective review. 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. 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. The docking technique allowed simplified graft tensioning and improved graft fixation.