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New surgical technique for treating recurrent elbow instability and dislocation

Authors: Olsen et al.

References: J Bone Joint Surg 2003;85-B:342-346

Abstract
A new reconstruction and reinforcement surgery is effective in the treatment of recurrent posterolateral instability of the elbow, according to a recent Dutch study.

Many patients report persistent instability of the elbow after traumatic dislocation and experience recurrent dislocation or painful radiohumeral subluxation. The lateral or radial collateral ligament (LCL) is the primary cause of the instability and a lesion in the LCL is the first stage of dislocation of the elbow.

Few surgical techniques have been described for the treatment of recurrent instability, including bone block procedures, tendon transfers and soft-tissue reconstructions of the lateral ligament. These procedures target the reconstruction or replacement of the ligament.

B.S. Olsen, MD, PhD, and J.O. Sojbjerg, MD, with the University Hospital, Nørrebrogade, Denmark, evaluated outcome of a newly described surgical LCL reconstruction and reinforcement procedure in patients with posterolateral instability of the elbow.

The procedure used in the study supplemented reconstruction with a triceps tendon graft from the ipsilateral elbow that was inserted through bone tunnels and fixed with bone anchors.

Surgery was performed on 18 patients (13 women and 5 men) between the ages of 14 and 50. Average follow up time was 44 months and ranged from 14 to 88 months.

At follow up, 78% (14) of patients were found to have a stable elbow and no further dislocations were reported. However, 22% (4) still had persistent apprehension to the pivot-shift stress test. All patients achieved a functional range of motion, with no reduction in range of motion to more than 5 degrees of extension or any loss of flexion in 83% of patients.

Overall, 94% of patients were satisfied with the outcome of their surgery and 83% were able to return to their pre-accident level of activity.

None of the patients reported severe or increased pain after surgery. Five patients reported moderate pain and 13 had no or only occasional slight pain, as assessed by visual analogue score.

According to the Mayo elbow performance score, 89% had an excellent or good result and 11% had a fair result. One patient was graded as a failure and had further surgery and another had severe pain in the elbow with persistent paralysis of the ulnar nerve present since initial dislocation.

No infections or neurological problems were observed at follow-up. One potential adverse event was an apparent decrease in the strength of extension of the elbow; however, further analysis is necessary due to statistical insignificance of the data collected.

Dr. Olsen recommends this procedure for the treatment of recurrent post-traumatic posterolateral instability of the elbow based on data that "it is safe and gives reliable results with regard to stability, movement and pain." Additionally, "only one incision is required whereas [in previously described techniques] a further incision is needed to harvest the tendon of palmaris longus."

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