Illustration of elbow joint with suture anchors reinforcing ligament fibers.

Elbow Instability? A New Surgical Fix Shows Promise

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"Mini-open aMCL plication with suture anchor: A potential game-changer for post-traumatic elbow laxity."

Elbow injuries, especially those affecting the medial collateral ligament (MCL), can significantly impact daily life and athletic performance. The MCL, comprised of the anterior bundle (aMCL), posterior bundle (pMCL), and transverse ligament, is crucial for elbow stability, particularly against valgus stress—the force that pushes the elbow outward.

Traditional treatments range from conservative measures like rest and physical therapy to more invasive reconstructions using grafts. However, graft-based reconstructions are complex, time-consuming, and can present complications. Now, a new surgical technique offers a promising alternative: mini-open aMCL plication with suture anchors.

This article explores this innovative procedure, detailing its surgical process, benefits, and potential for restoring elbow stability and function after trauma. It provides insights into how this technique directly addresses aMCL laxity and enhances overall elbow mechanics.

How Does This New Elbow Surgery Work?

Illustration of elbow joint with suture anchors reinforcing ligament fibers.

The mini-open aMCL plication is designed to restore stability to the elbow by addressing laxity in the anterior bundle of the medial collateral ligament. The procedure involves a few key steps, starting with a thorough arthroscopic evaluation.

First, the surgeon assesses the aMCL using a 70° arthroscope, which allows for a direct view of the ligament's condition from inside the joint. Special attention is paid to whether the coronoid process (a part of the ulna) is correctly positioned within the trochlea (a part of the humerus). Lateral subluxation, or displacement, of the coronoid process can indicate medial elbow instability.

Ulnar Nerve Release: A limited release of the ulnar nerve is performed to prevent nerve damage or instability.
aMCL Plication: The aMCL is plicated—folded and secured—using suture anchors inserted into the humerus at the ligament's original attachment point. This effectively tightens the ligament.
Arthroscopic Reassessment: A final arthroscopic evaluation ensures proper tensioning of the plicated aMCL and restoration of the joint space.

Post-surgery, a structured rehabilitation protocol is followed, beginning with a period of immobilization followed by progressive range-of-motion exercises and strengthening. Valgus stress is avoided for several months to allow for proper healing.

Is This a Better Option for Elbow Instability?

The mini-open aMCL plication offers a potentially less invasive and more anatomic approach compared to traditional MCL reconstructions using grafts. By plicating the existing ligament rather than replacing it, the technique aims to restore natural elbow mechanics with potentially fewer complications.

While promising, this procedure is best suited for patients with partial ligament degeneration and may not be appropriate for cases of severe MCL damage. Preoperative MRI evaluation is crucial to assess the extent of ligament damage and determine the suitability of this technique.

Further research with larger patient groups and longer follow-up periods will help to solidify the role of mini-open aMCL plication in the treatment of medial elbow instability. However, the initial results suggest that it is a reliable and effective option for carefully selected patients seeking to regain elbow stability and function.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s12306-018-0554-8, Alternate LINK

Title: Reliability Of Anterior Medial Collateral Ligament Plication Of The Elbow

Subject: Orthopedics and Sports Medicine

Journal: MUSCULOSKELETAL SURGERY

Publisher: Springer Science and Business Media LLC

Authors: P. Arrigoni, F. Luceri, D. Cucchi, J. Tamini, P. S. Randelli

Published: 2018-10-01

Everything You Need To Know

How does the mini-open aMCL plication procedure actually work to fix elbow instability?

The mini-open aMCL plication involves first assessing the aMCL with an arthroscope to check for correct positioning of the coronoid process within the trochlea. Then, a limited ulnar nerve release is performed. The aMCL is then folded and secured with suture anchors at its original attachment point on the humerus to tighten the ligament. A final arthroscopic evaluation ensures proper tensioning. Post-surgery includes immobilization followed by progressive exercises, while avoiding valgus stress during healing.

Why is the medial collateral ligament (MCL) so important for elbow stability?

The medial collateral ligament (MCL) is crucial for elbow stability, specifically against valgus stress. The MCL is composed of the anterior bundle (aMCL), posterior bundle (pMCL), and transverse ligament. Injuries to this ligament, especially the aMCL, can lead to elbow instability and impact daily life and athletic performance. The new procedure focuses on addressing laxity in the aMCL.

What are the potential advantages of the mini-open aMCL plication over traditional graft-based MCL reconstruction?

The mini-open aMCL plication offers a less invasive and more anatomic approach compared to traditional MCL reconstructions using grafts. By plicating the existing aMCL rather than replacing it, the technique aims to restore natural elbow mechanics with potentially fewer complications. Graft-based reconstructions can be more complex, time-consuming, and have a higher risk of complications.

What is valgus stress, and why is it important to avoid it after undergoing the mini-open aMCL plication?

Valgus stress is the force that pushes the elbow outward. The medial collateral ligament (MCL), particularly the anterior bundle (aMCL), is vital for resisting this force. When the aMCL is lax or injured, the elbow becomes unstable under valgus stress, leading to pain and functional limitations. Avoiding valgus stress after the mini-open aMCL plication is crucial to allow proper healing and prevent re-injury.

Why is ulnar nerve release a necessary step during the mini-open aMCL plication?

Ulnar nerve release is performed during the mini-open aMCL plication to prevent nerve damage or instability. The ulnar nerve runs close to the medial elbow, and surgical manipulation in that area can put it at risk. Releasing the nerve ensures it is not compressed or stretched during or after the aMCL plication, reducing the risk of nerve-related complications like numbness or tingling in the hand and fingers.