Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 10, pp 3284–3290 | Cite as

Dual reconstruction of lateral collateral ligament is safe and effective in treating posterolateral rotatory instability of the elbow

  • Hyoung Seok Jung
  • Jae Sung Lee
  • In Hyeok Rhyou
  • Ho Won Lee
  • Min Jong ParkEmail author



Although reconstruction of the lateral ulnar collateral ligament (LUCL) has been considered the procedure of choice for posterolateral rotatory instability (PLRI), recent studies have reported that the entire lateral collateral ligament complex (LCLC), rather than its posterior part only, contributes to preventing PLRI. Thus, it was hypothesized that dual reconstruction of the radial collateral ligament (RCL) and LUCL for the treatment of elbow PLRI could provide favourable clinical results regardless of the mechanism of injury.


This retrospective study reviewed the clinical results of 21 patients who underwent dual reconstruction of the RCL and LUCL between 2011 and 2016. Functional outcomes were assessed using the numeric rating scale (NRS) score, Mayo Elbow Performance Score (MEPS), quick Disabilities of the Arm, Shoulder, and Hand (quick DASH) score, and manual varus instability. To identify any difference in outcomes according to the aetiologies for LCLC insufficiency, our patients were divided into LCLC insufficiency associated with elbow dislocation and that with lateral epicondylitis.


At a median follow-up of 27 months (range 13–65 months), all patients showed resolved instability and achieved a functional arc of motion. In addition, lateral pivot shift tests were negative in all patients. The median MEPS significantly improved after surgery from 70 (range 60–75) to 85 (range 75–100) (p < 0.001), while the median quick DASH score improved from 38.6 (range 26.6–54.5) to 11.4 (range 0–34.1) (p < 0.001). Clinical outcomes according to the aetiology of LCLC insufficiency were not significantly different except for the NRS score.


The results suggest that the dual reconstruction technique leads to a clinical outcome similar to that of conventional LUCL reconstruction in LCLC insufficiency regardless of aetiology. In addition, the dual reconstruction technique was technically easier than the conventional LUCL reconstruction technique and may be a potential alternative when a bone tunnel created at the proximal ulna by the original technique has failed.

Level of evidence



Lateral ulnar collateral ligament Dual reconstruction Lateral epicondylitis Clinical outcomes Radial collateral ligament 



This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

This study was approved by the Institutional Review Board of Samsung Medical Centre (no. 2018-02-154-001).

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Anakwenze OA, Kancherla VK, Iyengar J, Ahmad CS, Levine WN (2014) Posterolateral rotatory instability of the elbow. Am J Sports Med 42:485–491CrossRefGoogle 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 30:866–871CrossRefGoogle Scholar
  3. 3.
    Arrigoni P, Cucchi D, D’Ambrosi R, Menon A, Aliprandi A, Randelli P (2017) Arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow (SMILE). Knee Surg Sports Traumatol Arthrosc 25:2264–2270CrossRefGoogle Scholar
  4. 4.
    Beckett KS, McConnell P, Lagopoulos M, Newman RJ (2000) Variations in the normal anatomy of the collateral ligaments of the human elbow joint. J Anat 197:507–511CrossRefGoogle Scholar
  5. 5.
    Broberg MA, Morrey BF (1987) Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res 216:109–119Google Scholar
  6. 6.
    Chanlalit C, Dilokhuttakarn T (2018) Lateral collateral ligament reconstruction in atraumatic posterolateral rotatory instability. JSES Open Access 2:121–125CrossRefGoogle Scholar
  7. 7.
    Chanlalit C, Limsricharoen W (2013) Posterolateral rotatory instability from multiple steroids injections for tennis elbow: a case report. J Med Assoc Thai 96(Suppl 1):S104–S107Google Scholar
  8. 8.
    Charalambous CP, Stanley JK (2008) Posterolateral rotatory instability of the elbow. J Bone Jt Surg Br 90:272–279CrossRefGoogle Scholar
  9. 9.
    Cohen MS (2008) Lateral collateral ligament instability of the elbow. Hand Clin 24:69–77CrossRefGoogle Scholar
  10. 10.
    Cohen MS, Bruno RJ (2001) The collateral ligaments of the elbow: anatomy and clinical correlation. Clin Orthop Relat Res 383:123–130CrossRefGoogle Scholar
  11. 11.
    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 25:943–948CrossRefGoogle Scholar
  12. 12.
    Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ (2001) Ligamentous stabilizers against posterolateral rotatory instability of the elbow. J Bone Jt Surg Am 83:1823–1828CrossRefGoogle Scholar
  13. 13.
    Dzugan SS, Savoie FH 3rd, Field LD, O’Brien MJ, You Z (2012) Acute radial ulno-humeral ligament injury in patients with chronic lateral epicondylitis: an observational report. J Shoulder Elbow Surg 21:1651–1655CrossRefGoogle Scholar
  14. 14.
    Goren D, Budoff JE, Hipp JA (2010) Isometric placement of lateral ulnar collateral ligament reconstructions: a biomechanical study. Am J Sports Med 38:153–159CrossRefGoogle Scholar
  15. 15.
    Hackl M, Wegmann K, Ries C, Leschinger T, Burkhart KJ, Muller LP (2015) Reliability of magnetic resonance imaging signs of posterolateral rotatory instability of the elbow. J Hand Surg Am 40:1428–1433CrossRefGoogle Scholar
  16. 16.
    Heo YM, Yi JW, Lee JB, Lee DH, Park WK, Kim SJ (2015) Unstable simple elbow dislocation treated with the repair of lateral collateral ligament complex. Clin Orthop Surg 7:241–247CrossRefGoogle Scholar
  17. 17.
    Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B (2002) The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Jt Surg Am 84:208–215CrossRefGoogle Scholar
  18. 18.
    Jackson A, Maerz T, Koueiter DM, Andrecovich CJ, Baker KC, Anderson K (2012) Strength of ulnar fixation in ulnar collateral ligament reconstruction: a biomechanical comparison of traditional bone tunnels to the tension-slide technique. J Shoulder Elbow Surg 21:1674–1679CrossRefGoogle Scholar
  19. 19.
    Jones KJ, Dodson CC, Osbahr DC, Parisien RL, Weiland AJ, Altchek DW, Allen AA (2012) The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes. J Shoulder Elbow Surg 21:389–395CrossRefGoogle Scholar
  20. 20.
    Kalainov DM, Cohen MS (2005) Posterolateral rotatory instability of the elbow in association with lateral epicondylitis. A report of three cases. J Bone Jt Surg Am 87:1120–1125CrossRefGoogle Scholar
  21. 21.
    Lin KY, Shen PH, Lee CH, Pan RY, Lin LC, Shen HC (2012) Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow. Injury 43:1657–1661CrossRefGoogle Scholar
  22. 22.
    Moritomo H, Murase T, Arimitsu S, Oka K, Yoshikawa H, Sugamoto K (2007) The in vivo isometric point of the lateral ligament of the elbow. J Bone Jt Surg Am 89:2011–2017Google Scholar
  23. 23.
    O’Driscoll SW (2000) Classification and evaluation of recurrent instability of the elbow. Clin Orthop Relat Res 370:34–43CrossRefGoogle Scholar
  24. 24.
    Reichel LM, Milam GS, Sitton SE, Curry MC, Mehlhoff TL (2013) Elbow lateral collateral ligament injuries. J Hand Surg Am 38:184–201CrossRefGoogle Scholar
  25. 25.
    Rhyou IH, Park MJ (2011) Dual reconstruction of the radial collateral ligament and lateral ulnar collateral ligament in posterolateral rotator instability of the elbow. Knee Surg Sports Traumatol Arthrosc 19:1009–1012CrossRefGoogle Scholar
  26. 26.
    Shim JW, Yoo SH, Park MJ (2018) Surgical management of lateral epicondylitis combined with ligament insufficiency. J Shoulder Elbow Surg 27:1907–1912CrossRefGoogle Scholar
  27. 27.
    Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthals-de Bos IB, Bouter LM (2002) Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet 359:657–662CrossRefGoogle Scholar
  28. 28.
    Takigawa N, Ryu J, Kish VL, Kinoshita M, Abe M (2005) Functional anatomy of the lateral collateral ligament complex of the elbow: morphology and strain. J Hand Surg Br 30:143–147CrossRefGoogle Scholar
  29. 29.
    Wegmann K, Burkhart KJ, Bingoel AS, Ries C, Neiss WF, Muller LP (2015) Anatomic relations between the lateral collateral ligament and the radial head: implications for arthroscopic resection of the synovial fold of the elbow. Knee Surg Sports Traumatol Arthrosc 23:3421–3425CrossRefGoogle Scholar
  30. 30.
    Zwerus EL, Somford MP, Maissan F, Heisen J, Eygendaal D, van den Bekerom MP (2018) Physical examination of the elbow, what is the evidence? A systematic literature review. Br J Sports Med 52:1253–1260CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryMedical Centre of Chung-Ang University School of MedicineSeoulSouth Korea
  2. 2.Department of Orthopaedic Surgery, Upper Extremity and Microsurgery CentrePohang SM Christianity HospitalPohangSouth Korea
  3. 3.Department of Orthopaedic SurgeryKangnam Sacred Heart Hospital, Hallym University School of MedicineSeoulSouth Korea
  4. 4.Department of Orthopaedic Surgery, Samsung Medical CentreSungKyunKwan University School of MedicineSeoulSouth Korea

Personalised recommendations