2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Pragmatic Comparative Study of Radial Head Replacement Without Lateral Ulnar Collateral Ligament Tear Versus Augmentation with Internal Brace Technique

Nikolaos Platon Sachinis, MD, PhD, Thessaloniki GREECE
Athanasios Patousis, MD, MSc(c),Phd(c), Thessaloniki GREECE
Nikiforos Galanis, MD, PhD, Thessaloniki GREECE
Panagiotis Givissis, M.D., Ph.D., Thessaloniki GREECE

General Hospital "Georgios Papanikolaou", Thessaloniki, GREECE

FDA Status Not Applicable

Summary

This pragmatic comparative study found that radial head replacement in patients without lateral ulnar collateral ligament (LUCL) tear provides outcomes comparable to those in patients with LUCL tear who underwent augmentation with the internal brace technique, with minimal functional impairment observed in both groups, particularly after the third month post-surgery.

Abstract

Introduction

The accompanying rupture of the lateral ulnar collateral ligament, particularly in cases of complex radial head fractures, can occur in up to 80% of cases. The outcomes of radial head replacement in such scenarios may not be optimal despite ligament augmentation.

Objective

To investigate the outcomes of radial head replacement and augmentation of the lateral ulnar collateral ligament in comparison to simple replacement in patients with and without rupture of this ligament.

Methods

From January 2021 to June 2023, 27 patients underwent radial head replacement surgery using the Antea modular mobile radial head prosthesis (Adler Ortho), which allows for 10° of freedom of movement around its center of rotation. The patients were divided into two groups: 15 without rupture of the lateral ulnar collateral ligament (Group A) and 12 with rupture (Group B), in whom the ligament was augmented using the “internal brace” technique. Patients with other associated ligament injuries or fractures were excluded. Postoperative outcomes were assessed using the Mayo Elbow Performance Score (MEPS), the Visual Analogue Scale (VAS), and the range of motion (ROM) of the elbow. Follow-up assessments were conducted at 6, 12, 24, and 52 weeks post-surgery. Statistical analysis was performed using the Mann-Whitney U test.

Results

By the third month, there was a statistically significant difference in elbow ROM (Group A ROM: median 5-132 degrees; Group B: median 14-126 degrees, p<0.001). Up to the final follow-up, no significant differences were observed in all scores, with a slight trend towards a median 10-degree extension loss in Group B (Group A ROM: median 0-137 degrees, Group B: median 10-136 degrees; Group A MEPS: median 100, Group B MEPS: median 94).

Conclusions

The results of radial head replacement, even with accompanying lateral ulnar collateral ligament augmentation, are satisfactory, particularly from the third month onward. In cases of augmentation using the internal brace technique, a residual extension deficit of the elbow was observed, though it did not cause functional impairment.