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Evaluation and Management of Posterolateral Rotatory Instability (PLRI)

  • Pieter Caekebeke
  • Megan Anne Conti Mica
  • Roger van RietEmail author
Chapter

Abstract

Posterolateral rotatory instability (PLRI) describes a pattern of ligamentous instability in which the proximal ulna and radial head externally rotate about the distal humerus when the forearm is positioned in supination and slight flexion. Insufficiency of both the static ligamentous stabilizers and the dynamic stabilizers of the posterolateral elbow is accepted as the cause with the lateral ulnar collateral ligament (LUCL) as the main static stabilizing component. This ligament originates at the lateral epicondyle and inserts onto the supinator crest. PLRI is generally considered in a continuum of stages ranging from minor laxity to recurrent elbow dislocations. Initial treatment is conservative. If the instability symptoms persist after adequate conservative treatment, surgical treatment can be considered. Invasive treatment varies from direct repair to the reconstruction of the lateral ligamentous complex. This chapter discusses the background, history and treatment of PLRI focusing on the diagnostic and surgical techniques.

Keywords

PLRI Instability Elbow Repair Reconstruction Arthroscopic Brace Pivot shift test 

Supplementary material

Video 10.1

Bone bridge at the proximal epicondyle. The free ends of the graft are prepared with a braided synthetic Krackow suture. The humeral tunnel is then prepared and two drill holes connected to the tunnel for suture and graft passage. With sutures passed through the humeral drill holes, the two ends of the graft are pulled into the humeral tunnel. It is important to make sure that the graft is of appropriate length so that the free limbs do not both bottom out in the humeral tunnel (MP4 653,201 kb)

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Pieter Caekebeke
    • 1
  • Megan Anne Conti Mica
    • 2
  • Roger van Riet
    • 3
    Email author
  1. 1.Department of OrthopedicAZ Monica, DeurneDeurne, AntwerpenBelgium
  2. 2.Department of OrthopedicsUniversity of ChicagoChicagoUSA
  3. 3.Department of Orthopedic Surgery and TraumatologyAZ MonicaDeurne, AntwerpenBelgium

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