Mid-term results of the treatment of acute postero-lateral rotational instability of the elbow joint

Abstract

Background: Dislocations of the forearm are rare injuries with the annual incidence of 6.1 cases per 100 000 population. Postero-lateral rotational instability is the most common complication after the conservative treatment of forearm dislocations. To restore the congruency and provide early movements in the elbow joint, the primary repair or reconstruction of the damaged ligaments of the elbow are required.

Aim: to evaluate the clinical and functional results after the surgical repair of the elbow joint ligaments in acute postero-lateral rotational instability.

Methods: The study was based on a retrospective analysis of a series of clinical cases, including 17 patients with acute postero-lateral rotational instability, among them 5 simple forearm dislocations, 9 fracture-dislocations of the forearm and 3 fractures of the radial head. Refixation of the lateral ulnar ligament was performed with anchor fixation or bone tunnels. The evaluation was performed using the clinical aspects (the «lateral pivot shift» test, the range of motion), according to the scale for the evaluation of the elbow joint functional condition (MEPS), Oxford scale of the elbow joint evaluation (OEC), the X-ray results were also estimated.

Results: In all the cases the elbow joint stability had been achieved, according to the X-ray and clinical aspects. In 4 cases, additional plasty of the medial collateral ligament was needed and performed after the restoration of the lateral ligament complex. According to the MEPS scale, 58% of the achieved results were excellent, 35% were good and 5.8% were satisfactory.

Conclusion: The restoration of the lateral ulnar collateral ligament complex is a safe and effective procedure, which restores the elbow joint stability and allows the patients to return to full physical activity and avoid the development of postero-lateral rotational joint instability.

Keywords

elbow joint / instability / lateral collateral ligament complex / lateral ulnar collateral ligament / forearm dislocation

References

[1] Mehta JA, Bain GI. Posterolateral rotatory instability of the elbow. J Am Acad Orthop Surg. 2004;12(6):405–415. doi: 10.5435/00124635-200411000-00005

[2] O’Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1991;(73):440–446. doi: 10.2106/00004623-199173030-00015

[3] Camp CL, Smith J, O’Driscoll SW. Posterolateral rotatory instability of the elbow: Part II. Supplementary examination and dynamic imaging techniques. Arthrosc Tech. 2017;6(2): e407–e411. doi: 10.1016/j.eats.2016.10.012

[4] Kim JW, Yi Y, Kim TK, et al. Arthroscopic lateral collateral ligament repair. J Bone Joint Surg Am. 2016;98(15):1268–1276. doi: 10.2106/JBJS.15.00811

[5] Tauber M. Wintersportverletzungen des Ellenbogengelenks. (In German). Orthopadie (Heidelb). 2022;51(11):903–909. doi: 10.1007/s00132-022-04315-9

[6] Eygendaal D, Olsen BS, Jensen SL, et al. Kinematics of partial and total ruptures of the medial collateral ligament of the elbow. J Shoulder Elbow Surg.1999;8(6):612–616. doi: 10.1016/s1058-2746(99)90099-x

[7] Bettuzzi C, Lucchesi G, Salvatori G, et al. Residual elbow instability in children with posterior or postero-lateral elbow dislocation. J Pediatr Orthop B. 2023;32(2):139–144. doi: 10.1097/BPB.0000000000001015

[8] Rodriguez MJ, Kusnezov NA, Dunn JC, Waterman BR, Kilcoyne KG. Functional outcomes following lateral ulnar collateral ligament reconstruction for symptomatic posterolateral rotatory instability of the elbow in an athletic population. J Shoulder Elbow Surg. 2018;27(1):112–117. doi: 10.1016/j.jse.2017.08.015

[9] Anakwe RE, Middleton SD, Jenkins PJ, et al. Patient-reported outcomes after simple dislocation of the elbow. J Bone Joint Surg Am. 2011;93(13):1220–1226. doi: 10.2106/JBJS.J.00860

[10] Itamura J, Roidis N, Mirzayan R, et al. Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg. 2005;14(4):421–424. doi: 10.1016/j.jse.2004.11.003

[11] Stoneback JW, Owens BD, Sykes J, et al. Incidence of elbow dislocations in the United States population. J Bone Joint Surg Am. 2012;94(3):240–245. doi: 10.2106/JBJS.J.01663

[12] Krticka M, Ira D, Flek M, et al. A Comparative study of conservative functional treatment versus acute ligamentous repair in simple dislocation of the elbow in adults. Indian J Orthop. 2018;52(6):584–589. doi: 10.4103/ortho.IJOrtho_578_16

[13] Calderazzi F, Garzia A, Leigheb M, et al. Simple and stable elbow dislocations: Results after conservative treatment. Acta Biomed. 2020;91(4-S):224–231. doi: 10.23750/abm.v91i4-S.9637

[14] Biz C, Crimì A, Belluzzi E, et al. Conservative versus surgical management of elbow medial ulnar collateral ligament injury: A systematic review. Orthop Surg. 2019;11(6):974–984. doi: 10.1111/os.12571

[15] Arrigoni P, Cucchi D, D’Ambrosi R, et al. Intra-articular findings in symptomatic minor instability of the lateral elbow (SMILE). Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2255–2263. doi: 10.1007/s00167-017-4530-x

[16] Kesmezacar H, Sarikaya IA. The results of conservatively treated simple elbow dislocations. Acta Orthop Traumatol Turc. 2010;44(3):199–205. doi: 10.3944/AOTT.2010.2400

[17] Mehlhoff TL, Noble PC, Bennett JB, et al. Simple dislocation of the elbow in the adult. Results after closed treatment. J Bone Joint Surg. 1988;70(2):244–249.

[18] Bell S. Elbow instability, mechanism and management. Curr Orthop. 2008;22(2):90–103. doi: 10.1016/j.cuor.2008.04.007

[19] Al-Ani Z, Tham JL, Ooi MW, et al. The radiological findings in complex elbow fracture-dislocation injuries. Skeletal Radiol. 2022;51(5):891–904. doi: 10.1007/s00256-021-03900-x

[20] Watts AC, Singh J, Elvey M, Hamoodi Z. Current concepts in elbow fracture dislocation. Shoulder Elbow. 2021;13(4):451–458. doi: 10.1177/1758573219884010

[21] Chang ES, Bishop ME, Dodson CC, et al. Management of elbow dislocations in the National Football League. Orthop J Sports Med. 2018;6(2).2325967118755451. doi: 10.1177/2325967118755451

[22] Rezaie N, Gupta S, Service BC, Osbahr DC. Elbow dislocation. Clin Sports Med. 2020;39(3):637–655. doi: 10.1016/j.csm.2020.02.009

[23] Vargas DG, Woodcock S, Porto GF, et al. Osborne-Coterril lesion a forgotten injury: Review article and case report. Clin Shoulder Elb. 2020;23(1):27–30. doi: 10.5397/cise.2019.00318

[24] Seo JB, Yi HS, Kim KB, Yoo JS. Clinical outcomes of arthroscopic lateral ulnar collateral ligament repair with or without intra-articular fracture. J Orthop Surg (Hong Kong). 2020;28(1):2309499020908348. doi: 10.1177/2309499020908348

[25] De Haan J, Goei H, Schep NW, et al. The reliability, validity and responsiveness of the Dutch version of the Oxford elbow score. J Orthop Surg Res. 2011;(6):39. doi: 10.1186/1749-799X-6-39

[26] Greiner S, Koch M, Kerschbaum M, Bhide PP. 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. 2019;27(10):3269–3275. doi: 10.1007/s00167-019-05402-9

[27] Kim BS, Park KH, Song HS, Park SY. Ligamentous repair of acute lateral collateral ligament rupture of the elbow. J Shoulder Elbow Surg. 2013;22(11):1469–1473. doi: 10.1016/j.jse.2013.06.018

[28] Lee JH, Lee JH, Kim KC, et al. Treatment of posteromedial and posterolateral dislocation of the acute unstable elbow joint: A strategic approach. J Shoulder Elbow Surg. 2019;28(10): 2007–2016. doi: 10.1016/j.jse.2019.05.029

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

[30] Cohen MS. Lateral collateral ligament instability of the elbow. Hand Clin. 2008;24(1):69–77. doi: 10.1016/j.hcl.2007.11.001

[31] Reichert IL, Ganeshamoorthy S, Aggarwal S, et al. Dislocations of the elbow: An instructional review. J Clin Orthop Trauma. 2021;(21):101484. doi: 10.1016/j.jcot.2021.101539

RIGHTS & PERMISSIONS

Eco-Vector