Arthroscopic and Open Radial Ulnohumeral Ligament (RUHL) Reconstruction for Posterolateral Rotatory Instability of the Elbow

Authors: Gurley, Savoie & Field

References: Presented at AAOS 2003

Abstract
Introduction: There has been a growing interest in the diagnosis and treatment of posterolateral rotatory instability (PLRI) of the elbow since the original description by O'Driscoll in 1991. This study reviews the authors' cumulative experience with an arthroscopic technique previously described by the senior authors and with open repair. Methods: A retrospective chart review was performed on all patients with elbow instability treated surgically by the senior authors (FHS and LDF). Sixty-five patients were identified and 60 of them had complete data available for review. Patients were evaluated for Andrews-Carson Scores, length of follow-up, surgical technique employed, age, sex, previous lateral epicondylar release. Results: The average follow-up was 36 months (range 12-69 months). Overall Andrews-Carson scores for all repairs improved from 143 to 185 p<0.0001. Subjective scores from 56-89 p<0.0001and objective scores improved from 86-95 p=0.037. Subdividing the technique yielded these overall results: arthroscopic repairs improved from 156 to 184 p=0.01 and open repairs 136 to 187 p<0.001. Discussion/Conclusions: Our study shows that arthroscopic plication of the radial ulnohumeral ligament (RUHL) can be as successful as open repair. It was interesting to note that 26% of patients had a previous lateral epicondylar release. While PLRI reconstruction/repair is an uncommon diagnosis/procedure, tennis elbow releases are performed by most orthopaedists. Treating physicians should be aware of the differential diagnosis of lateral elbow pain and be aware of the close proximity of the RUHL at the time of surgery.