Arthroscopic Treatment of Annular Drive Through and Radial Lateral Collateral Ligament Articular-Side Tear of the Elbow

Abstract

An elongation or partial articular-sided tear of the radial lateral collateral ligament (R-LCL) is a rare injury causing disability and instability of the elbow. In our experience this condition is often associated with a pathologic sign of the annular ligament named the "annular drive through" caused by a redundancy of the ligament. The benefits of performing an arthroscopic procedure for surgical stabilization of the R-LCL include smaller incisions with less soft-tissue dissection, better visualization of the joint, better repair accessibility, and elimination of the annular drive-through sign. The main steps of the operation are as follows: evaluation of annular drive through, inspection of the radial side of the joint, anterior capsulotomy, insertion of a suture anchor through the anterolateral portal, shuttling of the suture anchor through the ligament, and elimination of the annular drive-through sign. By use of this technique, it is possible to repair a lesion of the R-LCL with a suture anchor that ensures an anatomic repair and, at the same time, returns the annular ligament to its physiological tension.

Arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow (SMILE)

“…Several daily activities such as most desk jobs are performed with the shoulder in moderate abduction, pronation of the hand and 50–70° of elbow flexion. With time, this varus/pronation moment created by the hand and the forearm could lead to elongation of the R‐LCL and annular ligament The ECRB proximal insertion is located just extra‐capsular and parallel to R‐LCL, in intimate association but easily distinguishable with the lateral collateral ligament [5, 16]. Within the SMILE theory, ECRB tendinopathy could be a consequence of R‐LCL elongation, as this structure acts as an extra‐articular secondary stabilizer resisting varus‐pronation stresses.…”

Clinical outcomes of arthroscopic lateral ulnar collateral ligament repair with or without intra-articular fracture

“…Savoie et al 13 reported that arthroscopic application of the LUCL was safe and effective for the treatment of chronic PLRI, and the results were comparable to those of open repair. We also preferred the arthroscopic application technique of Savoie et al 13 and Arrigoni et al 14 to avoid sutures from ripping out and to increase suture strength. Savoie et al 13 and Arrigoni et al 14 passed the suture through the annular ligament.…”

“…We also preferred the arthroscopic application technique of Savoie et al 13 and Arrigoni et al 14 to avoid sutures from ripping out and to increase suture strength. Savoie et al 13 and Arrigoni et al 14 passed the suture through the annular ligament. It is possible to use a rip-stop stitch because the direction of annular ligament fibers is perpendicular to the direction of the LCL complex fibers.…”

Arthroscopic Reinsertion of Lateral Collateral Ligament, Anterior Capsular Plication, and Coronoid Tunneling Technique for Chronic Elbow Posterolateral Rotatory Instability

“…11 Moreover, an arthroscopic approach allows the surgeon to identify and treat minor injuries, such as a lesion of the articular portion of the radial collateral ligament or the annular drive-through, that would not be identifiable with an open procedure. 12 Lee and Teo 13 performed reconstruction with a tendon graft in 6 elbows and reattachment of the LUCL to the humerus in 4 for clinically symptomatic PLRI of the elbow. They noted that the tendon graft appeared to produce better results than the reattachment of the injured ligament by itself in achieving an excellent outcome.…”