Introduction
Surgical treatment helps restore stability to the elbow in patients with posterolateral rotatory instability (PLRI). The anconeus muscle is one of the most important active stabilizers against PLRI. A minimally invasive anconeus sparing approach for lateral ulnar collateral ligament (LUCL) reconstruction using a triceps tendon autograft has been previously described. The purpose of this study was to evaluate the outcome of this intervention and identify risk factors that influenced the clinical and patient reported outcomes. The hypothesis is that the LUCL reconstruction will lead to a significant more stable elbow.
Methods
61 patients with chronic PLRI and no previous elbow surgery that underwent surgical reconstruction of the LUCL using a triceps tendon autograft in a minimally invasive anconeus sparing approach during 2012 and 2018 were assessed. Outcome measures included a clinical examination and the Oxford Elbow Score (OES), the Mayo Elbow Performance Score (MEPS), the Disability of the Arm and Shoulder and Hand (DASH) questionnaires and the Visual analogue scale (VAS) for pain. Patient satisfaction was assessed with the Subjective Elbow Value (SEV) and school grade. Clinical stability of the elbow was evaluated with the Push-up Test, the Pivot-shift test, Stand-up test and the pincer grip. Integrity of the common extensor tendons and centering of the radial head were assessed on standardized MRIs.
Results
The average age of the patients was 52 years with a mean follow up of 53 months (range 27-86). Clinical examination after surgery showed no clinical signs of instability (P<.001) and a non-significant improvement in range of motion (P>.05). OES, MEPS, DASH and VAS averaged 40 out of 48 points (SD: 10), 92 out of 100 (SD:12), 9 out of 100 (SD: 14) and 1 (SD:2), respectively; all corresponding with good or excellent outcomes. Only one patient had to undergo revision surgery due to pain and there were no postoperative complications in this cohort. Superior functional results were observed in patients without radius subluxation on the MRI with a confirmed rupture of the LUCL.
Conclusion
The anconeus sparing minimally invasive technique for posterolateral stabilization of the elbow using a triceps tendon autograft is an effective and safe treatment for chronic posterolateral instability of the elbow with substantial improvements in elbow function and pain relief.