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

Abstract

Objectives: Describing our initial experience of performing box-loop ligament reconstruction in patients with chronically unreduced elbow dislocation. Design: Retrospective review. Setting: One tertiary referral centre. Patients/participants: Six patients treated with box-loop ligament reconstruction from 2015 to 2018 were included in this study. Intervention: Box-loop ligament reconstruction. Main outcome measurement: Quick disabilities of the arm, shoulder and hand (Q-DASH) and Mayo elbow performance index (MEPI) score. Results: All subjects exhibited substantial increase of range of flexion-extension motion of the affected elbow, from a mean of 24.2 initially to 119.2 postoperatively during the follow-up period (median ¼ 14 months, range 12e31 months). The subjects recorded an average MEPI score of 82.5 points, and average Q-DASH score of 16.2 points. There were no complications that occurred. Conclusions: This is the first case series of patients with chronically unreduced elbow dislocation treated with box-loop ligament reconstruction. Using this technique, all subjects had excellent outcome without any complication. Further studies with larger samples and better methodology are required to investigate the safety and efficacy of such technique.

Modified Graft Loop Technique Augmented With Nonabsorbable Suture Tape for Chronic Elbow Dislocation

“…Reconstruction of the MCL and LCL complex in chronic elbow dislocation using a looped graft around the humerus and the ulna, has been reported in the past 5,7,8. Van Riet et al8 in 2006 first described an MCL and LCL reconstruction technique using the gracilis graft.…”

“…This patient group commonly necessitate open reduction and ligament reconstruction and may have a less favorable final outcome. Several soft tissue techniques have been described in order to restore stability and preserve elbow joint function 5–8…”

“…Pasternack et al9 in 2020 reported a final ROM of 106 degrees of flexion-extension, that is consistent with standard techniques used for terrible triad and complex elbow dislocation injuries. Various techniques for the augmentation and reconstruction of acute and chronic elbow dislocations have been reported 5–8,10. Greiner et al11 in acute elbow dislocations supplemented the repair of the lateral ulnar collateral ligament (LUCL) with a nonabsorbable suture tape.…”

Interposition Arthroplasty in Untreated Chronic Dislocation of the Elbow

“…The chronicity of the injury is defined by its persistence of longer than 3 weeks 5 ; this entails a change in the anatomical structures of the joint that prevent its reduction, in addition to cyclical damage to the ligament and cartilaginous structure of the elbow. 3 , 6 , 7 …”

“…diagnostic and therapeutic approach because most of the patients received primary care in rural areas whose first contact was a family doctor and their proper assessment was delayed, this being the cause of the persistence of the lesion. 3,4 The chronicity of the injury is defined by its persistence of longer than 3 weeks 5 ; this entails a change in the anatomical structures of the joint that prevent its reduction, in addition to cyclical damage to the ligament and cartilaginous structure of the elbow. 3,6,7 Elbow instability associated with bone structures in chronic dislocations ranges from 30% for fractures of the coronoid process and 40% for radial head fractures.…”