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

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.

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Correspondence to Stefan Greiner.

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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.

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

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Greiner, S., Koch, M., Kerschbaum, M. et al. 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. Knee Surg Sports Traumatol Arthrosc 27, 3269–3275 (2019). https://doi.org/10.1007/s00167-019-05402-9

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Keywords

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