Dual reconstruction of lateral collateral ligament is safe and effective in treating posterolateral rotatory instability of the elbow

Abstract

Purpose Although reconstruction of the lateral ulnar collateral ligament (LUCL) has been considered the procedure of choice for posterolateral rotatory instability (PLRI), recent studies have reported that the entire lateral collateral ligament complex (LCLC), rather than its posterior part only, contributes to preventing PLRI. Thus, it was hypothesized that dual reconstruction of the radial collateral ligament (RCL) and LUCL for the treatment of elbow PLRI could provide favourable clinical results regardless of the mechanism of injury. Methods This retrospective study reviewed the clinical results of 21 patients who underwent dual reconstruction of the RCL and LUCL between 2011 and 2016. Functional outcomes were assessed using the numeric rating scale (NRS) score, Mayo Elbow Performance Score (MEPS), quick Disabilities of the Arm, Shoulder, and Hand (quick DASH) score, and manual varus instability. To identify any diference in outcomes according to the aetiologies for LCLC insuiciency, our patients were divided into LCLC insuiciency associated with elbow dislocation and that with lateral epicondylitis. Results At a median follow-up of 27 months (range 13-65 months), all patients showed resolved instability and achieved a functional arc of motion. In addition, lateral pivot shift tests were negative in all patients. The median MEPS signiicantly improved after surgery from 70 (range 60-75) to 85 (range 75-100) (p < 0.001), while the median quick DASH score improved from 38.6 (range 26.6-54.5) to 11.4 (range 0-34.1) (p < 0.001). Clinical outcomes according to the aetiology of LCLC insuiciency were not signiicantly diferent except for the NRS score. ConclusionThe results suggest that the dual reconstruction technique leads to a clinical outcome similar to that of conventional LUCL reconstruction in LCLC insuiciency regardless of aetiology. In addition, the dual reconstruction technique was technically easier than the conventional LUCL reconstruction technique and may be a potential alternative when a bone tunnel created at the proximal ulna by the original technique has failed. Level of evidence IV.

Treatment Outcomes of Simple Elbow Dislocations

“…The ROM was reported in 21 studies 8,13,19-37 . PROMs were reported in 24 studies 5,8,13,18-27,29,30,33-35,37-42 . The postintervention MEPS was the only PROM reported in all groups.…”

“…Twelve articles 8,20,21,23,27-30,37,39,40,45 reported on 228 elbows that underwent surgery in a timely manner. Of these, 225 patients reported in the same 12 articles 8,20,21,23,27-30,37,39,40,45 underwent closed reduction before surgery, while 3 elbows underwent open reduction 23 .…”

“…The ROM was reported in 21 studies 8,13,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] . PROMs were reported in 24 studies 5,8,13,[18][19][20][21][22][23][24][25][26][27]29,30,[33][34][35][37][38][39][40][41][42] . The postintervention MEPS was the only PROM reported in all groups.…”

The lateral ulnar collateral ligament: Anatomical and structural study for clinical application in the diagnosis and treatment of elbow lateral ligament injuries

“…In this sense, some authors argue for the reconstruction of a triangular area of the joint capsule between the lateral epicondyle, the lateral part of the coronoid process and the posterior part of the radial notch of the ulna (Fukai et al, 2022). However, surgical repair of the LUCL and techniques for LUCL reconstruction have given positive results in treating posterolateral instability (Dargel et al, 2015; Jung et al, 2019; Lee & Teo, 2003; Rhyou & Park, 2011). This makes an accurate anatomical description of LUCL dissection crucial for assisting the surgical approach and also for improving image diagnosis of LCL injuries, together with the possibility of specific surgical repair of the LUCL.…”

Repair Versus Non‐Repair of Lateral Ulnar Collateral Ligament in Elbow Varus Posteromedial Rotatory Instability Treatment: A Comparative Study

“…If the surgeon is inexperienced, it is possible to keep the LCL in a tense state, which can cause iatrogenic PLRI, and patients may be at risk of reoperation 4 . Recurrent instability was observed in 8% of cases after LUCL reconstruction 15 .…”