Box-loop technique in the management of complex elbow instability: a prospective controlled trial

Abstract

Introduction: Chronic elbow instability is a disable complication. This prospective study reports our experience with the box-loop reconstruction technique, compared with traditional Lateral Collateral Ligament (LCL) and eventual Medial Collateral Ligament (MCL) reconstruction, showing its functional outcome at 12-month follow-up. Methods: From January 2013 to February 2017, 27 patients with complex elbow instability were recruited. Group-A patients were managed using box-loop technique; in Group-B patients LCL reconstruction was performed and MCL lesions were always intraoperatively tested, under fluoroscopy, and eventually treated. Clinical evaluations were performed at baseline (T0) and at 1month (T1), 6-month (T2) and 12-month (T3) follow-up. X-rays were performed at T0 and T3. Intergroup and intragroup variability was assessed. Results: In all the patients, an improvement of both the range of movement and the joint stability was observed after surgery. The mean increase in flexion-extension arch was 52° in Group-A patients at 12-month follow-up. A significant improvement (p<0.05) of Mayo Elbow Performance Score, Oxford Elbow Scores and Visual Analogue Scale was observed at 12-month follow-up in both groups. Conclusion: Box-loop technique revealed safe and effective in the management of multidirectional elbow instability. Level of evidence: IV, Cases Series.

Chronically unreduced elbow dislocation treated with box-loop ligament reconstruction: The first case series

“…Our study is limited by the small number of subjects. However, our findings confirm the data reported by Finkbone et al 6 and Vicenti et al, 7 which found satisfactory short-term outcomes of box-loop reconstruction. Further studies with larger samples and longer follow-up are required to better investigate the efficacy and safety of this technique.…”

“…Two studies have performed this technique in chronic elbow instability, and it is found to be a safe and effective technique. 6,7 In this series, we describe our experience in treating patients with chronically unreduced elbow dislocation using box-loop ligament reconstruction. To our knowledge, this is the first report of patients with such conditions undergoing box-loop reconstruction.…”

“…Moreover, they found that this technique had an excellent biomechanical profile with respect to graft stiffness. In a recent prospective study of 27 subjects with complex elbow stability, Vicenti et al 7 found that the subjects had increased range of movement, and the whole joint stability was not We performed open reduction, plating, and temporary radial head replacement on the left elbow (F). A year later, union was achieved, and the plate and temporary radial head were removed; then, the elbow was reconstructed by using semitendinosus tendon graft.…”

Reconstruction Surgeries for Management of Posterolateral Rotatory Instability of The Elbow: A Systematic Review

“…It is associated with chronic pain, joint instability, recurrent subluxation/dislocation, and limited range of movement, thus affecting patients' daily lives. 17 This systematic review focused on cases with PLRI managed by LUCLR. It is to be noted that results of articles on LUCLR for PLRIE were mainly published in case reports or series, 18,19 which were excluded from the present systematic review.…”