Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Systematic Review

Hand ◽  
2020 ◽  
pp. 155894472091776
Author(s):  
Austin Fares ◽  
Nicholas Kusnezov ◽  
John C. Dunn
Keyword(s):  
Systematic Review ◽  
Elbow Dislocation ◽  
Ulnar Collateral Ligament ◽  
Tendon Graft ◽  
Common Mechanism ◽  
Collateral Ligament ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Additional Surgery ◽  
Lateral Ulnar Collateral Ligament

Background: Posterolateral rotatory instability (PLRI) is a common form of recurrent elbow instability. The aim of this systematic review is to present the outcomes and complications of lateral ulnar collateral ligament (LUCL) reconstruction surgery for PLRI. Methods: A literature search of LUCL reconstructions was performed, identifying 99 potential papers; 11 of which met inclusion/exclusion criteria, accounting for 148 patients. Papers were included if they reviewed cases of PLRI from 1976 to 2016 with reported outcome measures. Data were pooled and analyzed focusing on patient demographics as well as subjective and objective patient outcomes and complications. Results: The average age of patients was 34 years with a mean follow-up time of 49.8 months. The most common mechanism of injury was a traumatic elbow dislocation (66%), followed by cubitus varus deformity (7%), and unknown mechanisms (7%). Overall, 90% of patients achieved elbow stability and 2.7% experienced a failed reconstruction that necessitated an additional surgery. Furthermore, 93% were satisfied with the outcome of the reconstruction, and 83% reported good to excellent outcomes with 11% reporting moderate to severe persistent pain. Nearly half (45%) of reconstructions were done using a palmaris longus tendon graft, 24% with a triceps tendon graft, and 7% with a synthetic graft. Conclusions: Outcomes following LUCL reconstruction for PLRI are excellent and revision rates are low. LUCL reconstruction is a safe and reliable procedure. Level of Evidence: IV Therapeutic

Reconstruction Surgeries for Management of Posterolateral Rotatory Instability of The Elbow: A Systematic Review

2021 ◽  
Vol 15 (9) ◽  
pp. 2999-3003
Author(s):  
Ahmed Ali Alrabai ◽  
Abdullah Fahad Raizah
Keyword(s):  
Systematic Review ◽  
Ligament Reconstruction ◽  
Meta Analysis ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
English Only ◽  
Lateral Ulnar Collateral Ligament ◽  
Ulnar Collateral Ligament Reconstruction

We aimed to investigate the indications, techniques, and results of lateral ulnar collateral ligament reconstruction (LUCLR) for posterolateral rotatory instability of the elbow (PLRI) by collecting currently available data. Several databases (PUBMED & EMBASE) were explored for articles published between 2010 and 2020. A search strategy was applied. Altogether, 2,583 studies were recovered for possible inclusion. After adjusting for duplicates, revision of methodology, exclusion of non-full text studies, and those in languages other than English, only four studies remained, which included 51 patients, with more males than females (56.9% and 43.1%, respectively). The patients’ mean age was 35.1 years. Eight patients (15.7%) were managed by the Docking technique in one retrospective study, while 43 patients (84.3%) were managed by the trans-osseous technique. Both trans-osseous and Docking techniques are safe and efficient in the management of PLRI cases. The trans-osseous technique has better functional and postoperative results and lesser complications. Mesh Words: posterolateral rotatory instability of the elbow; lateral ulnar collateral ligament reconstruction surgery; systematic review; meta-analysis

Indications, Outcomes, and Complications of Lateral Ulnar Collateral Ligament Reconstruction of the Elbow for Chronic Posterolateral Rotatory Instability: A Systematic Review

2020 ◽  
pp. 036354652092741
Author(s):  
Shreya Badhrinarayanan ◽  
Ankit Desai ◽  
Jay James Watson ◽  
Callum Hoy Reid White ◽  
Joideep Phadnis
Keyword(s):  
Systematic Review ◽  
Surgical Technique ◽  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Complication Rates ◽  
Collateral Ligament ◽  
Recurrent Instability ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Lateral Ulnar Collateral Ligament

Background: Posterolateral rotatory instability (PLRI) of the elbow can lead to pain, recurrent dislocations, and, in the worst-case scenario, disability. Purpose: To report the indications, outcomes, and complication rates of lateral ulnar collateral ligament (LUCL) reconstruction for chronic PLRI of the elbow. Study Design: Systematic review. Methods: This systematic review was registered with PROSPERO and performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The review entailed 17 studies that included 168 patients with isolated LUCL reconstruction for chronic PLRI. Patients with concurrent medial collateral ligament reconstruction were excluded. The primary outcome measures were patient characteristics, indication for surgery, surgical technique, functional outcomes, and complications. Results: Chronic PLRI commonly occurred after a previous traumatic injury (n = 168). Of these, there were 119 simple instabilities (no fracture) and 33 complex instabilities (associated fracture). In 11 patients, PLRI was iatrogenic. The cause was unknown in 5 patients. Grafts used were autograft (n = 102; 61%), allograft (n = 18; 11%), synthetic graft (n = 15; 9%), and unknown (n = 33; 20%). The most common surgical technique was a docking procedure or a modification of this (n = 145; 86%). Other techniques included suture anchors (n = 18; 11%), nonanatomic (n = 1; 0.6%), and unknown (n = 4; 2%). There were 45 complications reported in 37 patients (22%). The most frequent complication was recurrent instability (21/138; 15%). No other major complications were reported. The rate of recurrent instability was significantly higher in revision reconstructions (6/15 elbows; 40%) compared with primary reconstructions (15/123 elbows; 12.2%) ( P = .005). The mean Mayo Elbow Performance Score and abbreviated Disabilities of the Arm, Shoulder and Hand score were 87.5 (range, 40-100) and 18.8 (range, 0-77), respectively. Of the patients in whom range of motion was measured, 134 of 144 patients (93%) regained a functional range (30L–130L). Conclusion: LUCL reconstruction for chronic PLRI proved a reliable method of reconstruction, save for the moderate rate of recurrent instability, which was highest in revision reconstructions.

Surgeon Experience Level Affects Mechanics of the Pivot Shift Test for Posterolateral Rotatory Instability of the Elbow

2009 ◽  
Author(s):  
Thomas Chu ◽  
Jen M. Ty ◽  
Bayram Orazov ◽  
Nicole Strauss ◽  
Oliver M. O’Reilly ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Ulnar Collateral Ligament ◽  
Pivot Shift Test ◽  
Full Extension ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Lateral Ulnar Collateral Ligament ◽  
Surgeon Experience ◽  
Improve Accuracy ◽  
Level Of Training

Posterolateral rotatory instability (PLRI) of the elbow occurs secondary to an injury to the lateral ulnar collateral ligament and lateral stabilizing structures [2]. The lateral pivot-shift test (PST) is a clinical examination for diagnosing PLRI [1]. The test involves moving the elbow from full extension to flexion while applying simultaneous supination torque, valgus moment, and axial compression [2]; a positive result is characterized by ulnohumeral subluxation that is seen clinically as posterolateral movement of the radial head and an incongruent radiocapitellar joint [2]. The PST is difficult to reliably reproduce in an office setting [3]. This can be due to patient-guarding or inexperience of the examiner. It is likely that the experienced examiner may perform the test differently from the inexperienced examiner. The PST has not previously been characterized biomechanically in the laboratory. Thus, the objective of this study is to fully characterize the biomechanics of the PST for PLRI. We will evaluate the repeatability of the PST across multiple surgeons and determine how the clinician’s level of training affects their method of testing. These results will be useful in developing training guidelines to standardize PST application as well as to improve accuracy.

Systematic Review of Elbow Instability in Association With Refractory Lateral Epicondylitis: Myth or Fact?

2021 ◽  
pp. 036354652098013
Author(s):  
Erica Kholinne ◽  
Hua Liu ◽  
Hyojune Kim ◽  
Jae-Man Kwak ◽  
Kyoung-Hwan Koh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Lateral Epicondylitis ◽  
Cochrane Library ◽  
Elbow Instability ◽  
Collateral Ligament ◽  
Steroid Injections ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Diagnostic Characteristics

Background: Elbow instability, particularly posterolateral rotatory instability (PLRI), has been reported in patients with refractory lateral epicondylitis (LE). However, evidence of diagnostic approach and surgical outcomes is lacking. Purpose: To identify (1) the risk factors, clinical and radiologic-diagnostic characteristics, and (2) the treatment options and clinical outcome of LE with PLRI. Study design: Systematic review. Methods: We searched the PubMed, Ovid/MEDLINE, Cochrane Library, Google Scholar, Scopus, and EMBASE databases using keywords as well as Medical Subject Headings terms and Emtree using “(lateral epicondylitis OR tennis elbow) AND (instability OR posterolateral rotatory instability)” for English-language studies. We conducted a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: In total, 8 articles comprising 6 level 4 and 2 level 3 studies were identified, including 249 patients (254 elbows). The main triggering factor was heavy labor activity (74/172; 43%). A total of 184 patients (73.9%) received either single (4/184; 2.2%) or multiple (180/184; 97.8%) steroid injections. Clinically, instability was always accompanied by pain in 9% of study individuals. Magnetic resonance imaging (MRI) revealed that radial collateral ligament (RCL) and lateral ulnar collateral ligament (LUCL) lesions were most common (18/79; 23%). The most common surgical procedure performed was arthroscopic RCL plication (62/120; 52%) followed by LUCL reconstruction (30/120; 25%). A ligament patholaxity sign was shown intraoperatively for 64% (44/69). Clinical outcomes ranged from good to excellent in all studies. The most common residual symptom was limited range of motion (11/18; 61%). Conclusion: Instability can coexist and may be associated with refractory LE. The risk factors of instability associated with refractory LE are heavy labor and multiple steroid injections. A systematic approach to identify the clinical and MRI presentation of the condition followed by examination under anesthesia are necessary for affirmative diagnosis, as independent presentations may be misleading.

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