Medial Ulnar Collateral Ligament Reconstruction (MUCL)

MUCL reconstruction surgery repairs the MUCL by reconstructing it with a tendon from the patient’s own body (autograft) or from a cadaver (allograft). The most frequently used tissue is the palmaris longus tendon in the forearm. The surgery is indicated for MUCL injury.

Medial Ulnar Collateral Ligament Injury

The medial ulnar collateral ligament (MUCL), is located on the inside of the elbow and connects the ulna bone to the humerus bone. It is one of the main stabilizing ligaments in the elbow especially with overhead activities such as throwing and pitching. When this ligament is injured or torn, it can end a professional athlete’s career unless surgery is performed. The common symptoms include:

  • Pain on the inner side of the elbow
  • Unstable elbow joint
  • Numbness in the little finger or ring finger
  • Decreased performance in activities such as throwing baseballs or other objects

Preparing for the Surgery

MUCL tear should be evaluated by an orthopedic specialist for proper diagnosis and treatment. Your physician will perform the following:

  • Medical history
  • Physical examination including a valgus stress test to assess for elbow instability

Other tests such as X-rays and MRI scans may be ordered to confirm the diagnosis.

Your physician will recommend conservative treatment options to treat the symptoms associated with MUCL injury unless you are a professional or collegiate athlete. In these cases, if the patient wants to continue in the sport, surgical reconstruction is performed.

Surgical Procedure

The basic steps for MUCL reconstruction surgery include the following:

  • The surgery is performed in an operating room under regional or general anesthesia
  • Your surgeon will make an incision over the medial epicondyle area
  • Care is taken to move muscles, tendons, and nerves out of the way
  • The donor's tendon is harvested from either the forearm or below the knee
  • Your surgeon drills holes into the ulna and humerus bones
  • The donor's tendon is then inserted through the drilled holes in a figure 8 pattern
  • The tendon is attached to the bone surfaces with special sutures
  • The incision is closed and covered with sterile dressings
  • Finally, a splint is applied with the elbow flexed at 90 degrees.

Postoperative Care

After surgery, your surgeon will give you guidelines to follow, depending on the type of repair performed and the surgeon’s preference. Common postoperative guidelines include:

  • Elevate your arm above heart level to reduce swelling
  • Wear an immobilizing splint or cast for 1-3 weeks
  • Apply ice packs to the surgical area to reduce swelling
  • Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering
  • Physical therapy will be ordered for strengthening and stretching exercises after the removal of the splint or cast
  • Professional athletes can expect a strenuous strengthening and range of motion rehabilitation program for 6-12 months before returning to their sport
  • Eating a healthy diet and not smoking will promote healing

Risks and Complications

As with any major surgery, there are potential risks involved.

The majority of patients suffer from no complications following MUCL Reconstruction surgery, however, complications can occur following elbow surgery and include:

  • Infection
  • Limited range of motion
  • Nerve damage causing numbness, tingling, burning or loss of feeling in the hand and forearm area
  • Cubital Tunnel Syndrome
  • Elbow instability
  • University of Notre Dame
  • Saint Joseph Health System
  • Beacon Health System
  •  American Academy of Orthopaedic Surgeons
  • The American Osteopathic Academy of Orthopedics
  • American Association of Hip and Knee Surgeons
  • American Board of Medical Specialties
  • American Board of Medical Specialties
  • American Board of Foot and Ankle Surgery
  • American Orthopaedic Foot & Ankle Society
  • American Orthopaedic Society for Sports Medicine
  • North American Spine Society
  • American Society for Surgery of the Hand
  • American Academy of Physician Assistants