Lateral collateral ligament reconstruction in atraumatic posterolateral rotatory instability

Abstract

BackgroundChronic elbow pain has several causes. Instability pain is one of the differential diagnosis. Posterolateral rotatory instability (PLRI) of the elbow results from lateral collateral ligament (LCL) insufficiency. This instability has been recognized in association with trauma of the elbow. The standard treatment of LCL insufficiency is ligament reconstruction with a tendon graft. Treatment outcome of LCL reconstruction in atraumatic PLRI cases has been rarely reported. This study reports the results of LCL reconstruction in patients with chronic lateral elbow pain from atraumatic PLRI.Materials and methodsData were collected from 36 patients referred to our institution for surgery because of chronic lateral elbow pain between November 2011 and June 2015. Six patients with atraumatic PLRI underwent LCL reconstruction with tendon graft. Demographic data, number of steroid injections, postoperative clinical examination, Mayo Elbow Performance Index, 11-item version of the Disabilities of the Arm, Shoulder and Hand score, and complications were recorded with a mean follow-up of 24 months.ResultsReconstruction resulted in significant improvement of pain. The mean postoperative Mayo Elbow Performance Index score was 97.5 (range, 95-100), and the score of the 11-item version of the Disabilities of the Arm, Shoulder, and Hand was 9 (range, 3.3-33). Postoperative instability test results were negative in all patients. Mean postoperative range of motion was 136° in flexion and 1° in extension. No complications were detected at the follow-up assessment.ConclusionsWe consider LCL reconstruction is one of the reference treatments for atraumatic PLRI because it provides effective and reliable results.

Systematic Review of Elbow Instability in Association With Refractory Lateral Epicondylitis: Myth or Fact?

“…15 The most common functional outcome tool used was the Disabilities of the Arm, Shoulder and Hand score. Of the 5 studies providing data on functional outcome, 3 studies (48 patients) 1,10,27 reported excellent results, 1 study 8 (6 patients) reported good to excellent results, and 1 study 14 (40 patients) indicated “no functional impairment” after surgical procedure. Data on postoperative ROM was reported for 57 patients, 49% (28/57) of whom described a loss of ROM.…”

“…The preoperative range of motion (ROM) and functional score were only documented in 171 patients. 1,8,10,15,27…”

“…The diagnosis of elbow instability associated with refractory LE is not straightforward due to the multifactorial etiology and potentially interfering conditions. 1,2,8,10,[13][14][15]27 Therefore, a systematic approach involving the identification of risk factors, clinical presentation, and radiologic findings is required. This systematic review showed that heavy labor activity serves as a major risk factor for triggering the instability in refractory LE.…”

“…The preoperative range of motion (ROM) and functional score were only documented in 171 patients. 1,8,10,15,27 Standard plain elbow radiographs had been taken for most of the patients. However, only 177 of 254 elbows (70%) had undergone a magnetic resonance imaging (MRI) examination (Figure 3).…”

“…4,13,20,22,25 Elbow instability, particularly posterolateral rotatory instability (PLRI), has been reported as a concurrent finding in refractory LE. 1,2,8,10,[13][14][15]27 Associated ligament insufficiency has been shown to induce elbow instability, and PLRI has been reported after a traumatic event, 10 corticosteroid injections, 1,2,8,[13][14][15]27 and iatrogenic injury during LE surgery. 19 These conditions may coexist, and when they do, it may be difficult to identify the main triggering factor.…”