Anterior Submuscular Transposition of the Ulnar Nerve at the Elbow with the Mitek Bone Suture Anchor

ABSTRACT

Anterior transposition is the current procedure of choice for cubital tunnel syndrome, and submuscular transposition offers some advantages over subcutaneous techniques. The need to protect the reattachment of the flexor pronator mass inhibits the ability to proceed with early range of motion postoperatively. The study evaluates the use of the Mitek GII (Norwood, Mass) bone suture anchor for secure attachment of the flexor pronator mass to allow immediate range of motion exercises. The result was a significant relief of preoperative pain, numbness, earlier return of strength, and less propensity towards flexion contractures and recurrent scarring.

Problems with the ulnar nerve at the elbow are more routinely diagnosed than they were previously. Because of this, significantly more patients undergo surgery. Difficulties with submuscular transposition mainly involve the inability to move the elbow early postoperatively, from fear of avulsion of the flexor pronator mass reattachment.

Difficulties prompted further exploration of early mobilization of the elbow following ulnar nerve surgery. A method of secure attachment was necessary to apply with minimal complications. The Mitek device was used with no complications. This procedure yields better results than those reported in the literature.

The study involves a surgeon’s experience in 122 cases over 8 years of submuscular transposition of the ulnar nerve with the Mitek bone anchor for the treatment of cubital tunnel. When using the Mitek device with early mobilization, patients have minimal, if any, problems with stiffness, and medial cutaneous nerve irritability at the elbow is less of a problem. Treatment and out-of-work time are substantially less than with other available procedures.

This procedure was safe, effective, and reliable while allowing early mobilization with predictable results and satisfactory fixation reliability. This is a helpful procedure in young patients who wish to proceed with aggressive early rehabilitation, as well as those with recurrent ulnar nerve problems requiring repeat surgery. The decreased down time as well as increased success rate justify the minor increased cost incurred by using the Mitek device.