Summary

Minor instability is a possible aetiology of lateral elbow pain and arthroscopic plication of the radial component of the lateral collateral ligamen produces subjective satisfaction and positive clinical results at 2-year median follow-up

Abstract

Background

Minor instability has been proposed as a possible aetiology of lateral elbow pain. This study presents the results of the arthroscopic plication of the radial component of the lateral collateral ligament (R-LCL) to reduce minor instability of the lateral elbow.

Methods

Twenty-seven patients with recalcitrant lateral epicondylitis who had failed conservative therapy and who had no previous trauma or overt instability, were included. R-LCL plication was performed in the presence of at least one sign of lateral ligamentous patholaxity and one intra- articular abnormal finding. Single-assessment numeric evaluation (SANE), Oxford Elbow Score (OES), quick- DASH (Disabilities of the Arm, Shoulder, Hand), patient satisfaction and post-operative range of motion were evaluated. The Shapiro–Wilk normality test was used to evaluate the normal distribution of the sample. Differences between pre- and post-operative SANE score were analysed with an unpaired Wilcoxon matched-pairs signed rank test.

Results

SANE improved from a median of 30 [2–40] points pre-operatively to 90 [80–100] at final follow-up (p < 0.0001), and 96.3% patients obtained good or excel- lent subjective results. Post-operative median quickDASH was 9.1 [0–25] points and OES 42 [34–48]. Median post-operative flexion was 145°, and extension was 0°. Post- operative flexion was restrained in seven patients and extension in eight patients; 59% of patients reached full ROM at final follow-up.

Conclusions

R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with a symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up. A slight limitation in range of motion is a possible undesired consequence of this intervention.