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

Abstract

Objective To compare the effects of repairing and not repairing the lateral ulnar collateral ligament (LUCL) when surgically treating elbow varus posteromedial rotatory instability (PMRI). Methods In this retrospective study spanning June 2014 to February 2019, 24 patients with elbow PMRI who were treated surgically were assigned to group RL (Repair LUCL) or group NL (Non‐repair LUCL) depending on whether the LUCL was repaired. Hospitalization time, operation time, intraoperative blood loss, and related complications were reviewed. The elbow range of motion (ROM), the visual analog scale (VAS), the Mayo elbow performance score (MEPS), and the disabilities of the arm, shoulder, and hand (DASH) score were used for functional assessment. Results Among the 24 patients with PMRI, 15 were assigned to group RL and nine were assigned to group NL. The mean blood loss (184.66 ± 20.3 vs 207.33 ± 19.447, P < 0.001), the operation time (98.88 ± 12.693 min vs 184.66 ± 20.3 min, P < 0.001) were significantly lower in group RL compared to group NL. There were no significant differences between the two groups in time until surgery and follow‐up time (6.66 ± 1.838 vs 6.11 ± 1.900 days, 25.53 ± 2.099 vs 26.11 ± 2.891 months, P = 0.577, P = 0.486). All of the patients achieved bone union. The elbow flexion‐extension ROM (122.00° ± 3.162°vs 121.11° ± 3.333° at 12 months, P = 0.520) and pronation‐supination ROM (154.53° ± 3.335° vs 155.55° ± 4.639° at 12 months, P = 0.537). Both groups achieved similar results in MEPS score (90.53 ± 2.695 vs 89.77 ± 3.865, P = 0.578) and DASH (9.77 ± 1.897 vs 9.99 ± 1.550, P = 0.772) score at the final follow‐up. And the MEPS score revealed excellent results (87% in group RL, 89% in group NL).The VAS scores decreased significantly in group RL (from 6.13 ± 0.990 to 1.93 ± 0.593) and group NL (from 5.77 ± 1.481 to 1.88 ± 0.781), and no significant differences in preoperative or final follow‐up were observed between the two groups (P = 0.487, P = 0.876). Complications observed in group NL with one patient occurred cubital tunnel syndrome 3 months after the operation, the patient underwent ulnar nerve simple neurolysis and the symptoms were relieved after 3 weeks. Conclusion For patients with elbow PMRI, satisfactory functional outcomes can be yielded with non‐repair of the LUCL as long as the stable elbow joint is performed during operation.

Surgical Treatment of Adams Type IV Anterolateral Fracture of the Ulna Coronoid Process

“…If the ulnar pulley joint can extend fully without dislocation under gravity after repairing the coronoid process, the radial head, and the LCL, there is usually no need to explore and repair the MCL. Even in elbow varus posteromedial rotatory instability, where the medial column is the main injury, satisfactory functional outcomes can be yielded with non‐repair of the LUCL as long as the stable elbow joint is performed during the operation 18 . After the anterior medial approach is used to fix the coronoid process fracture, an intraoperative valgus test is required: using the C‐arm to monitor the widening gap between the lower humerus‐radial joint.…”

“…Even in elbow varus posteromedial rotatory instability, where the medial column is the main injury, satisfactory functional outcomes can be yielded with non‐repair of the LUCL as long as the stable elbow joint is performed during the operation. 18 After the anterior medial approach is used to fix the coronoid process fracture, an intraoperative valgus test is required: using the C‐arm to monitor the widening gap between the lower humerus‐radial joint. If the valgus test is positive, the lateral approach must be used to repair the LCL.…”