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Medial Ulnar Collateral Ligament Reconstruction Using Hamstring Allograft in Overhead Throwing Athletes
Felix H. Savoie, III, MD1; Craig Morgan, MD2; Jeffrey Yaste, MD3; James Hurt, MD1; Larry Field, MD3
1 Tulane University Department of Orthopaedic Surgery, 1430 Tulane Avenue SL-32, New Orleans, LA 70112. E-mail address for F.H. Savoie III: fsavoie@tulane.edu
2 Morgan Kalman Clinic, 2501 Silverside Road, Wilmington, DE 19810
3 Mississippi Sports Medicine and Orthopaedic Center, 1325 East Fortification Street, Jackson, MS 39202
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Investigation performed at Tulane University, New Orleans, Louisiana, and Morgan Kalman Clinic, Wilmington, Delaware

A commentary by Matthew V. Smith, MD, is linked to the online version of this article at jbjs.org.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jun 19;95(12):1062-1066. doi: 10.2106/JBJS.L.00213
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Currently, several graft options have been described for reconstruction of the medial ulnar collateral ligament of the elbow. Palmaris longus, gracilis, plantaris, toe extensor, and even Achilles tendon autografts have been well documented. To our knowledge, no study has investigated the clinical outcomes following the use of allograft tendon for primary medial ulnar collateral ligament reconstruction. It is our hypothesis that medial ulnar collateral ligament reconstruction with hamstring allograft provides results similar to those reported with autograft without the potential complication or risk of donor-site morbidity.


We retrospectively reviewed the records for 123 overhead throwing athletes with medial ulnar collateral ligament injuries who had had unsuccessful nonoperative treatment. All patients were managed with reconstruction with use of a hamstring allograft and were followed for a minimum of twenty-four months. One hundred and sixteen of the 123 patients were contacted and were included in our study. Outcome measures included Conway-Jobe rating scale, the mean time to return to play, the maximum level of competition, and overall satisfaction with the reconstruction.


At the time of the most recent follow-up, 110 of the 116 patients had returned to play. Thirty-three (30%) of these 110 athletes had returned to a level of play above that prior to injury, sixty-four (58%) had returned to play at the same level, and thirteen (12%) had returned to level of play lower than that that prior to the injury. The mean time to return to play was 9.9 months. One hundred and fourteen of the 116 patients who were contacted considered the reconstruction to be successful. The Conway-Jobe score was classified as excellent for 80% of the patients, good for 13%, fair for 7%, and poor for none.


The use of allograft tissue for the reconstruction of the medial ulnar collateral ligament in throwing athletes provides outcomes similar to that of autograft tissue after twenty-four months of follow-up.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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