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Modified Ligament Surgery Improves Outcomes Players, Athletes

tring and then grafted into the elbow to act as a replacement for the injured ligament.

Surgeons weave the harvested tendon in a figure eight pattern through bone tunnels drilled in the ulna and humerus bones and suture the tendon into place.

Dr. Altchek’s technique modifies the Jobe procedure in several ways. First, he begins with an arthroscopic evaluation of the elbow to examine and fix residual problems. An unstable ligament leads to a shifting elbow, which can cause further problems such as cartilage damage.

Second, Dr. Altchek gains access to the bone in a different way. In the Jobe surgery, surgeons detach major muscles and move the so-called ulnar nerve out of the way to gain access to the bone. Dr. Altchek uses a muscle splitting technique through which surgeons can gain access to the bone by gently prying apart muscle fibers, similar to the way you can poke a finger through a knitted sweater. He doesn’t have to detach major muscles and, in most cases, the nerve can be left intact, reducing the problems of postoperative nerve damage. Damage to the ulnar nerve results in numbness and tingling in the ring and small fingers.

Dr. Altchek’s procedure also differs from the traditional Jobe surgery by minimizing the number of holes drilled into the bones, thus decreasing the risk of postoperative bone fracture. In Dr. Altchek’s surgery only one hole instead of three is drilled into the humerus. Instead of a figure eight design, one can think of the pattern as an elongated D, says Christopher Dodson, M.D., a resident in the Department of Orthopaedic Surgery at HSS and an author of the study.

“In the classic operation, the graft enters the humerus bone in one hole, exits in another and goes into another and then the graft gets tied to itself,” Dr. Altchek explained. In the docking procedure, the graft enters the humerus bone, but never exits. Instead, sutures secure the tendon and exit the bone through muc
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