Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 10, pp 3269–3275 | Cite as

Repair and augmentation of the lateral collateral ligament complex using internal bracing in dislocations and fracture dislocations of the elbow restores stability and allows early rehabilitation

  • Stefan GreinerEmail author
  • Matthias Koch
  • Maximilian Kerschbaum
  • Pushkar P. Bhide
ELBOW

Abstract

Purpose

Most elbow dislocations can be treated conservatively, with surgery indicated in special circumstances. Surgical options, apart from fracture fixation, range from repair or reconstruction of the damaged ligaments to static external fixation, usually entailing either a long period of immobilization followed by carefully monitored initiation of movement or dynamic external fixation. In general, no consensus regarding surgical treatment has been reached. A new method of open ligament repair and augmentation of the lateral ulnar collateral ligament using a non-absorbable suture tape in cases of acute and subacute elbow instability following dislocations has been described here, which allows an early, brace-free initiation of the full range of motion. This is the first description of the technique of internal bracing of the lateral elbow with preliminary patient outcome parameters for acute treatment of posterolateral rotatory instability.

Methods

Seventeen patients (14 males and 3 females) with acute or subacute posterolateral elbow instability as a result of dislocation or fracture dislocation were treated in our centre (Sporthopaedicum, Straubing, Regensburg, Germany) from 2014 to 2015 with open LUCL re-fixation and non-absorbable suture tape augmentation. The elbows were actively mobilized immediately after the operation and a maximum bracing period of 3 days.

Results

At 10 month median follow-up, none of the patients showed clinically apparent signs of instability or suffered subluxation or re-dislocation. One patient required re-operation for heterotopic ossification. The median range of motion was from 10° (0–40) to 130° (90–50) and median Oxford, Mayo Elbow Performance score, Simple Elbow Value, and DASH Scores were 41(29–48), 100 (70–100), 83% (60–95), and 18.5 (1.6–66), respectively. All patients reported a complete return to pre-injury level of activity.

Conclusion

Augmentation with a non-absorbable suture tape acting as an ‘Internal Brace’ following an elbow dislocation is a safe adjunct to primary ligament repair and may allow the early mobilization and recovery of elbow stability and range of motion.

Level of evidence

IV.

Keywords

Elbow dislocation Ligament augmentation Elbow instability Internal brace Early mobilization Brace-free mobilization 

Notes

Compliance with ethical standards

Conflict of interest

It is hereby declared that none of the above-mentioned authors or their family members have received any financial remuneration related to the subject of the article. Neither is there any conflict of interest with respect to the subject of the article.

Ethical approval

Ethical approval was obtained from the Institutional Ethical Committee at the Technical University (Technische Üniversität), Dresden, under the application no. EK377102014.

References

  1. 1.
    Alaia MJ, Shearin JW, Kremenic IJ, McHugh MP, Nicholas SJ, Lee SJ (2015) Restoring isometry in lateral ulnar collateral ligament reconstruction. J Hand Surg Am 40(7):1421–1427CrossRefGoogle Scholar
  2. 2.
    Anakwenze OA, Kwon D, O’Donnell E, Levine WN, Ahmad CS (2014) Surgical treatment of posterolateral rotatory instability of the elbow. Arthroscopy 30(7):866–871CrossRefGoogle Scholar
  3. 3.
    Basmajian JV, Griffin WRJ (1972) Function of anconeus muscle. An electromyographic study. J Bone Jt Surg Am 54(8):1712–1714CrossRefGoogle Scholar
  4. 4.
    Chapleau J, Canet F, Petit Y, Laflamme GY, Rouleau DM (2011) Validity of goniometric elbow measurements: comparative study with a radiographic method. Clin Orthop Relat Res 469(11):3134–3140CrossRefGoogle Scholar
  5. 5.
    Cohen MS, Hastings H 2nd (1997) Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers. J Bone Jt Surg Am 79(2):225–233CrossRefGoogle Scholar
  6. 6.
    Cusick MC, Bonnaig NS, Azar FM, Mauck BM, Smith RA, Throckmorton TW (2014) Accuracy and reliability of the Mayo Elbow Performance Score. J Hand Surg Am 39(6):1146–1150CrossRefGoogle Scholar
  7. 7.
    Daluiski A, Schrumpf MA, Schreiber JJ, Nguyen JT, Hotchkiss RN (2014) Direct repair for managing acute and chronic lateral ulnar collateral ligament disruptions. J Hand Surg Am 39(6):1125–1129CrossRefGoogle Scholar
  8. 8.
    Dargel J, Boomkamp E, Wegmann K, Eysel P, Muller LP, Hackl M (2017) Reconstruction of the lateral ulnar collateral ligament of the elbow: a comparative biomechanical study. Knee Surg Sports Traumatol Arthrosc 25(3):943–948CrossRefGoogle Scholar
  9. 9.
    Duckworth AD, Ring D, Kulijdian A, McKee MD (2008) Unstable elbow dislocations. J Shoulder Elbow Surg 17(2):281–286CrossRefGoogle Scholar
  10. 10.
    Dugas JR, Walters BL, Beason DP, Fleisig GS, Chronister JE (2016) Biomechanical comparison of ulnar collateral ligament repair with internal bracing versus modified jobe reconstruction. Am J Sports Med 44(3):735–741CrossRefGoogle Scholar
  11. 11.
    Hackl M, Leschinger T, Müller LP, Wegmann K (2016) Chronic ligamentous instability of the elbow. Orthopade 45(10):809–821CrossRefGoogle Scholar
  12. 12.
    Hopf JC, Berger V, Krieglstein CF, Muller LP, Koslowsky TC (2015) Treatment of unstable elbow dislocations with hinged elbow fixation-subjective and objective results. J Shoulder Elbow Surg 24(2):250–257CrossRefGoogle Scholar
  13. 13.
    Iordens G, Den Hartog D, Tuinebreijer WE, Eygendaal D, Schep NWL, Verhofstad MHJ, Van Lieshout EMM (2017) Minimal important change and other measurement properties of the Oxford Elbow Score and the Quick Disabilities of the Arm, Shoulder, and Hand in patients with a simple elbow dislocation; validation study alongside the multicenter FuncSiE trial. PLoS One 12(9):e0182557CrossRefGoogle Scholar
  14. 14.
    Kim BS, Park KH, Song HS, Park SY (2013) Ligamentous repair of acute lateral collateral ligament rupture of the elbow. J Shoulder Elbow Surg 22(11):1469–1473CrossRefGoogle Scholar
  15. 15.
    Kim JW, Yi Y, Kim TK, Kang HJ, Kim JY, Lee JM et al (2016) Arthroscopic lateral collateral ligament repair. J Bone Jt Surg Am 98(15):1268–1276CrossRefGoogle Scholar
  16. 16.
    King GJW, Dunning CE, Zarzour ZDS, Patterson SD, Johnson JA (2002) Single-strand reconstruction of the lateral ulnar collateral ligament restores varus and posterolateral rotatory stability of the elbow. J Shoulder Elbow Surg 11(1):60–64CrossRefGoogle Scholar
  17. 17.
    Koh KH, Lim TK, Lee HI, Park MJ (2013) Surgical treatment of elbow stiffness caused by post-traumatic heterotopic ossification. J Shoulder Elbow Surg 22(8):1128–1134CrossRefGoogle Scholar
  18. 18.
    O’Brien MJ, Lee Murphy R, Savoie FH 3rd (2014) A preliminary report of acute and subacute arthroscopic repair of the radial ulnohumeral ligament after elbow dislocation in the high-demand patient. Arthroscopy 30(6):679–687CrossRefGoogle Scholar
  19. 19.
    O’Brien MJ, Savoie FH 3rd (2014) Arthroscopic and open management of posterolateral rotatory instability of the elbow. Sports Med Arthrosc Rev 22(3):194–200CrossRefGoogle Scholar
  20. 20.
    O’Driscoll SW (2000) Classification and evaluation of recurrent instability of the elbow. Clin Orthop Relat Res 370:34–43CrossRefGoogle Scholar
  21. 21.
    Phillips BB (2017) Recurrent dislocations. In: Azar FM, Beaty JH, Canale ST (eds) Campbell’s operative orthopaedics, vol 3, 13th edn. Elsevier, Philadelphia, p 2390Google Scholar
  22. 22.
    Salazar D, Golz A, Israel H, Marra G (2014) Heterotopic ossification of the elbow treated with surgical resection: risk factors, bony ankylosis, and complications. Clin Orthop Relat Res 472(2):2269–2275CrossRefGoogle Scholar
  23. 23.
    Sanchez-Sotelo J, Morrey BF, O’Driscoll SW (2005) Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Jt Surg Br 87(1):54–61CrossRefGoogle Scholar
  24. 24.
    Schnetzke M, Aytac S, Keil H, Deuss M, Studier-Fischer S, Grutzner PA, Guehring T (2017) Unstable simple elbow dislocations: medium-term results after non-surgical and surgical treatment. Knee Surg Sports Traumatol Arthrosc 25(7):2271–2279CrossRefGoogle Scholar
  25. 25.
    Schreiber JJ, Warren RF, Hotchkiss RN, Daluiski A (2013) An online video investigation into the mechanism of elbow dislocation. J Hand Surg 38(3):488–494CrossRefGoogle Scholar
  26. 26.
    Smith JP 3rd, Savoie FH 3rd, Field LD (2001) Posterolateral rotatory instability of the elbow. Clin Sports Med 20(1):47–58CrossRefGoogle Scholar
  27. 27.
    Walters BL, Cain EL, Emblom BA, Frantz JT, Dugas JR (2016) Ulnar collateral ligament repair with internal brace augmentation: a novel UCL repair technique in the young adolescent athlete. Orthop J Sports Med 4(3):3Google Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Sporthopaedicum, Straubing and RegensburgStraubingGermany
  2. 2.Department of Trauma SurgeryUniversity Medical CentreRegensburgGermany

Personalised recommendations