Indications, Outcomes, and Complications of Lateral Ulnar Collateral Ligament Reconstruction of the Elbow for Chronic Posterolateral Rotatory Instability: A Systematic Review

Abstract

Background: Posterolateral rotatory instability (PLRI) of the elbow can lead to pain, recurrent dislocations, and, in the worst-case scenario, disability. Purpose: To report the indications, outcomes, and complication rates of lateral ulnar collateral ligament (LUCL) reconstruction for chronic PLRI of the elbow. Study Design: Systematic review. Methods: This systematic review was registered with PROSPERO and performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The review entailed 17 studies that included 168 patients with isolated LUCL reconstruction for chronic PLRI. Patients with concurrent medial collateral ligament reconstruction were excluded. The primary outcome measures were patient characteristics, indication for surgery, surgical technique, functional outcomes, and complications. Results: Chronic PLRI commonly occurred after a previous traumatic injury (n = 168). Of these, there were 119 simple instabilities (no fracture) and 33 complex instabilities (associated fracture). In 11 patients, PLRI was iatrogenic. The cause was unknown in 5 patients. Grafts used were autograft (n = 102; 61%), allograft (n = 18; 11%), synthetic graft (n = 15; 9%), and unknown (n = 33; 20%). The most common surgical technique was a docking procedure or a modification of this (n = 145; 86%). Other techniques included suture anchors (n = 18; 11%), nonanatomic (n = 1; 0.6%), and unknown (n = 4; 2%). There were 45 complications reported in 37 patients (22%). The most frequent complication was recurrent instability (21/138; 15%). No other major complications were reported. The rate of recurrent instability was significantly higher in revision reconstructions (6/15 elbows; 40%) compared with primary reconstructions (15/123 elbows; 12.2%) ( P = .005). The mean Mayo Elbow Performance Score and abbreviated Disabilities of the Arm, Shoulder and Hand score were 87.5 (range, 40-100) and 18.8 (range, 0-77), respectively. Of the patients in whom range of motion was measured, 134 of 144 patients (93%) regained a functional range (30L–130L). Conclusion: LUCL reconstruction for chronic PLRI proved a reliable method of reconstruction, save for the moderate rate of recurrent instability, which was highest in revision reconstructions.

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability After Failed Common Extensor Origin Release: Outcomes at Minimum 2-Year Follow-up

“…3,43 The association of LCLC insufficiency and chronic LE as well as treatment recommendations have been described before. 4,21,43 However, clinical results after LUCL reconstruction for chronic PLRI as a salvage procedure are lacking.…”

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

“…This depicts the rarity of this clinical condition and the difficulties we face in diagnosing and managing it, resulting in a literature shortage to describe those specific characteristics and the effectiveness of management strategies. 4 Our systematic review included four articles that underlined the clinical outcomes in 51 patients with PLRI managed by the Docking or interosseous techniques. In spite of differences in the adopted surgical techniques, the reported outcomes by all included studies indicated that LUCLR is effective in achieving lateral elbow stability.…”

“…3 Most frequently LUCL occurs due to trauma. 4 Moreover, its dysfunction may occur as a result of iatrogenic injuries, e.g., surgery of the lateral side of elbow; repeated steroid injections for lateral epicondylitis; or in chronic varus deformity as a complication of a supracondylar fracture of children. Insufficient LUCL will lead to symptomatic PLRI with time.…”

Recommendations from the ICM-VTE: Shoulder & Elbow

“…There are available only retrospective studies or case reports 150,151 . A recent systematic review 146 on the outcome and complications of lateral ulnar collateral ligament reconstruction of the elbow for posterolateral rotatory instability has shown an incidence of deep venous thrombosis (DVT) of 0.60%. Sanchez-Sotelo et al 151 , reported only one case of DVT, with an incidence of 2%, in 44 patients undergoing ligament repair for posterolateral rotatory instability of the elbow.…”

“…Rationale: Controversies remain whether or not the patients undergoing ligament reconstruction surgery for elbow instability [146][147][148] should be routinely administered VTE prophylaxis.…”