Skip to main content
SpringerLink
Log in

Revision Allograft Reconstruction of the Lateral Collateral Ligament Complex in Elbows With Previous Failed Reconstruction and Persistent Posterolateral Rotatory Instability

  • Symposium: Traumatic Elbow Instability and its Sequelae
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Primary reconstruction of the lateral collateral ligament complex (LCLC) using graft tissue restores elbow stability in many, but not all, elbows with acute or chronic posterolateral rotatory instability (PLRI). Revision reconstruction using a tendon allograft is occasionally considered for persistent PLRI, but the outcome of revision ligament reconstruction in this setting is largely unknown.

Questions/purposes

We determined whether revision allograft ligament reconstruction can (1) restore the stability and (2) result in improved elbow scores for patients with persistent PLRI of the elbow after a previous failed primary reconstructive attempt and in the context of the diverse pathology being addressed.

Methods

Between 2001 and 2011, 160 surgical elbow procedures were performed at our institution for the LCLC reconstruction using allograft tissue. Only patients undergoing revision allograft reconstruction of the LCLC for persistent PLRI with a previous failed primary reconstructive attempt using graft tissue and at least I year of followup were included in the study. Eleven patients (11 elbows) fulfilled our inclusion criteria and formed our study cohort. The cohort consisted of six female patients and five male patients. The mean age at the time of revision surgery was 36 years (range, 14–59 years). The revision allograft reconstruction was carried out after a mean of 3 years (range, 2.5 months to 9 years) from a failed attempted reconstruction of the LCLC. Osseous deficiency to some extent was identified in the preoperative radiographs of eight elbows. Mean followup was 5 years (range, 1–12 years).

Results

Revision allograft reconstruction of the LCLC restored elbow stability in eight of the 11 elbows; two of the three elbows with persistent instability were operated on a third time (at 6 and 7 months after allograft revision reconstruction). For elbows with no persistent instability, the mean Mayo Elbow Performance Score at most recent followup was 83 points (range, 60–100 points), and six elbows were rated with a good or excellent result. All patients with persistent instability had some degree of preoperative bone loss.

Conclusions

Revision allograft reconstruction of the LCLC is an option for treating recurrent PLRI, although this is a complex and resistant problem, and nearly ½ of the patients in this cohort either had persistent instability and/or had a fair or poor elbow score.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–C

Similar content being viewed by others

References

  1. Beaton DE, Wright JG, Katz JN. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87:1038–1046.

    Article  PubMed  Google Scholar 

  2. Eygendaal D. Ligamentous reconstruction around the elbow using triceps tendon. Acta Orthop Scand. 2004;75:516–523.

    Article  PubMed  Google Scholar 

  3. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608.

    Article  CAS  PubMed  Google Scholar 

  4. Jones KJ, Dodson CC, Osbahr DC, Parisien RL, Weiland AJ, Altchek DW, Allen AA. The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes. J Shoulder Elbow Surg. 2012;21:389–395.

    Article  PubMed  Google Scholar 

  5. Lin KY, Shen PH, Lee CH, Pan RY, Lin LC, Shen HC. Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow. Injury. 2012;43:1657–1661.

    Article  PubMed  Google Scholar 

  6. Morrey BF, An KN. Functional evaluation of the elbow. In: Morrey BF, Sanchez-Sotelo J, eds. The Elbow and its Disorders. Philadelphia, PA: Elsevier Inc; 2009:80–91.

    Chapter  Google Scholar 

  7. Nestor BJ, O’Driscoll SW, Morrey BF. Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1992;74:1235–1241.

    CAS  PubMed  Google Scholar 

  8. O’Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1991;73:440–446.

    PubMed  Google Scholar 

  9. Olsen BS, Sojbjerg JO. The treatment of recurrent posterolateral instability of the elbow. J Bone Joint Surg Br. 2003;85:342–346.

    Article  CAS  PubMed  Google Scholar 

  10. Sanchez-Sotelo J. Lateral collateral ligament insufficiency. In: Morrey BF, Sanchez-Sotelo J, eds. The Elbow and its Disorders. Philadelphia, PA: Elsevier Inc; 2009:669–679.

    Chapter  Google Scholar 

  11. Sanchez-Sotelo J, Morrey BF, O’Driscoll SW. Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Br. 2005;87:54–61.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Yaser M. K. Baghdadi MD, Bernard F. Morrey MD, Shawn W. O’Driscoll MD, PhD, Scott P. Steinmann MD & Joaquin Sanchez-Sotelo MD, PhD

Authors
  1. Yaser M. K. Baghdadi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bernard F. Morrey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shawn W. O’Driscoll MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Scott P. Steinmann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joaquin Sanchez-Sotelo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joaquin Sanchez-Sotelo MD, PhD.

Additional information

The institution of the authors has received, during the study period, funding from Stryker Orthopaedics (Mahwah, NJ, USA), Zimmer, Inc (Warsaw, IN, USA), and DePuy Orthopaedics, Inc (Warsaw, IN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Baghdadi, Y.M.K., Morrey, B.F., O’Driscoll, S.W. et al. Revision Allograft Reconstruction of the Lateral Collateral Ligament Complex in Elbows With Previous Failed Reconstruction and Persistent Posterolateral Rotatory Instability. Clin Orthop Relat Res 472, 2061–2067 (2014). https://doi.org/10.1007/s11999-014-3611-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-014-3611-0

Keywords

Search

Navigation