Anterior transposition is the procedure of choice today for cubital tunnel syndrome, and submuscular transposition appears to offer 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 post-operatively. This study evaluates the use of the Mitek GII (Norwood, MA) bone suture anchor for secure attachment of the flexor pronator mass to allow immediate range of motion exercises. This resulted in a significant relief of pre-operative pain, numbness, earlier return of strength, and less propensity towards flexion contractures and recurrent scarring.

Problems with the ulnar nerve at the elbow are much more routinely diagnosed than they were previously. Due to this, there are significantly more patients receiving surgery. Difficulties with submuscular transposition mostly involve our inability to move the elbow early post-operatively, due to fear of avulsion of the flexor pronator mass reattachment.

The aforementioned difficulties prompted us to further explore the concept of very early mobilization of the elbow following ulnar nerve surgery. To do this we needed a method of secure attachment that was also easy to apply with minimal complications. The Mitek device certainly lends itself to this and carries with it a very low problem or complication rate. In fact, we have had no complications. This procedure yields better results than those reported in the literature.

This study involves one 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 times and out of work time are substantially less than with the other procedures available.

We have found this procedure to be safe, effective, and reliable while allowing early mobilization with predictable results and good reliability of fixation. This is a particularly helpful procedure in patients who are young and wish to proceed with aggressive early rehabilitation as well as those with recurrent ulnar nerve problems requiring repeat surgery. We believe that the decreased down time, as well as increased success rate justify the minor increased cost incurred by using the Mitek device.