2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Elbow Lateral Ulnar Collateral Ligament Reconstruction by Transposition of the Local Extensor Fascia Septum: Surgical Technique and Preliminary Results

Angelo De Crescenzo , MD, Bari ITALY
Raffaele Garofalo, MD, Acquaviva Delle Fonti-Ba ITALY
Andrea Celli, MD, Modena, Modena ITALY

Hesperia Hospital, Modena, Modena, ITALY

FDA Status Not Applicable

Summary

Local extensor fascia septum transposition may represent a useful alternative to other approaches using tendon autografts/allografts when a reconstruction technique is required for chronic LUCL lesion and poor ligament quality.

Abstract

The lateral ulnar collateral ligament (LUCL) is a primary lateral stabilizer of the elbow that originates from the isometric center of the capitulum and inserts into the supinator crest of the ulna. LUCL injury may be due to trauma, chronic strain, or iatrogenic lesion. In patients with symptomatic LUCL insufficiency and recurrent posterolateral rotatory instability, surgical reconstruction can restore elbow stability. In primary acute treatment, the injured LUCL is reattached to the lateral epicondyle with transosseous sutures and anchors placed at the isometric origin of the ligament. If the ligament quality is poor, patients with chronic elbow instability may require reconstruction with a tendon autograft or allograft. Alternatively, the LUCL can be reconstructed by transposition of the local extensor fascia septum, a local flap that exploits the common extensor fascia connected to a thin strip of extensor digitorum quinti or the extensor digitorum communis intermuscular septum. We describe a new LUCL reconstruction technique based on the transposition of the local extensor fascia septum and report the preliminary result in a series of patients aged 50 years or less.
From 2017 to 2019, 10 consecutive patients with chronic PLRI of the elbow 7 men and 3 women underwent LUCL reconstruction with transposition of the local extensor fascia septum at our institution. PLRI had developed after a documented traumatic dislocation of the elbow. Physical examination demonstrated severe limitations in daily living and sports activities in all cases. Before surgery, varus instability with anteroposterior dynamic examination under fluoroscopy and a positive lateral pivot shift test were observed in all cases. To manage the chronic PLRI, the common extensor fascial band is folded around the split septum as a rotation flap and mobilized, sparing the epicondyle insertion. Imbricated Krackow locking sutures are placed along the anterior and posterior aspects of the rotation flap, which provides a new ligament. A plane under the extensor carpi ulnaris (ECU) and extensor digitorum quinti (EDQ) tendons and above the supinator muscle fibers is carefully developed using blunt scissors so that the graft can be rotated posterior to the ulnar insertion and passed through it. To ensure alignment with the native ligament, the new ligament is fixed with a suture anchor to the isometric point identified at the center of the lateral epicondyle. A groove for the rotation flap (1-1.5x0.5 cm) is then excavated in the supinator crest and three holes are then drilled into its bottom on the ulnar border and the graft sutures are passed through them. The new ligament is laid in the groove, the sutures are tied with the forearm in full pronation and the elbow at 40° of flexion.
At a mean follow-up of 26 months (range, 24-30), 9 patients (90%) reported a completely stable elbow. All clinical measures improved significantly (P < .05): the mean MEPS from 79 (79.5 ± 8.32) to 98 (98.5 ± 4.74); the mean Quick- DASH score from 15.4 (15.47 ± 4.76) to 0.9 (0.91 ± 1.58), and the mean VAS score from 3.6 (3.6 ± 2.32) to 0.2 (0.2 ± 0.63). Local extensor fascia septum transposition may represent a useful alternative to other approaches using tendon autografts/allografts when a reconstruction technique is required for chronic LUCL lesion and poor ligament quality.