Arthroscopic and Open Radial Ulnohumeral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow

Abstract

The diagnosis of posterolateral rotatory instability (PLRI) of the elbow is made by a combination of patient history and physical examination. The diagnosis may be confirmed by radiologic studies, such as MRI arthrography. Four clinical tests for PLRI are described: (1) supine pivot shift, (2) prone pivot shift, (3) internal rotation wall push-up, and (4) chair push-up. While nonoperative management usually yields satisfactory results, surgery may be indicated for recurrent instability or in high-level athletes. At the time of surgery, instability can be confirmed arthroscopically by several findings, including abnormal movement of the radial head on the capitellum, varus opening of the radiocapitellar joint, and the arthroscopic “drive through sign of the elbow.”

This report describes a ligament repair technique and a plication technique, both of which can be performed either arthroscopically or open with a high rate of success. Arthroscopic repair of the RUHL can effectively stabilize an elbow with PLRI, returning patients to pre-injury sports participation while producing a high degree of patient satisfaction.