Summary

Internal Bracing in posttraumatic instability of the elbow led to good subjective and objective score results.

Abstract

Introduction

A tear of the lateral ulnar collateral ligament (LUCL) with/without tear of the medial collateral ligament (MCL) leads to PLRI or bilateral elbow instability. The majority of these injuries can be treated conservatively. Indications for surgery are persisting instability, osseous lesions or extensive soft tissue damage.
The aim of this study is to evaluate clinical results of internal bracing in postero-lateral Instability (PLRI) of the elbow with or without medial elbow instability. The hypothesis is that internal bracing allows early postoperative mobilization and thereby avoids stiffness without endanger stability.

Methods

Between 2013-2019 43 patients with a mean age of 38,8 years (18-67), were treated with internal bracing and included in this study.
After diagnostic arthroscopy and treatment of accompanying lesions refixation and internal bracing of the LUCL complex was performed with an absorbable tape and knotless anchors. In cases with significant medial instability, refixation and internal bracing of the MCL was performed in the same session. All patients were treated without a splint and immediately mobilized.
The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Visual Analogue Scale (VAS), and subjective evaluation of the postoperative result were evaluated. Clinical stability of the elbow was evaluated with the Push-up Test, the Pivot-shift test, Stand-up test and the pincer grip.

Results

The mean follow-up was 3,5 ± 1,6 years (2-8). Postoperative ROM improved significantly (extension/flexion) mean: 0/6/144 (range: 0/0-70/130-150) in comparison to Pre-OP mean: 0/21/122 (range: 0/0-70/60-150) p<0,05. At FU the mean score results were: OES: 39,2 ± 9 (11-48) points, MEPS: 85,2 ± 18,6 (30-100) and the VAS was 1,5 (0-8±2,1). Patients evaluated the operation postoperatively by school marks (1-6) by a mean of 1,9. There were no clinical signs of persistent instability in clinical testing in any patient.

Conclusion

Internal Bracing in posttraumatic instability of the elbow led to good subjective and objective score results. Early mobilization allowed to regain almost full ROM without persistent instability.