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Posterolateral rotatory instability of the elbow

  • ELBOW SOFT TISSUE SURGERY (L OH, SECTION EDITOR)
  • Published:
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Abstract

Posterolateral rotatory instability of the elbow is often caused by a complex injury to the lateral ulnar collateral ligament complex. This often leads to chronic mechanical symptoms of instability and pain. Surgical repair or reconstruction of the ligament is often required to stabilize the radiocapitellar joint. Multiple techniques have been described in the literature for repair or reconstruction of the lateral ligamentous complex with overall good clinical outcomes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. O’Driscoll S, Bell D, Morrey BF. Posterolateral instability of the elbow. J Bone Joint Surg. 1991;73:440–6. This is the classic original article describing posterolateral instability of the elbow and the first description of surgical repair and outcomes.

    PubMed  Google Scholar 

  2. Anakwenze OA, Kwon D, O’Donnell E, Levine WN, Ahmad CS. Surgical treatment of posterolateral rotatory instability of the elbow. Arthrosc - J Arthrosc Relat Surg. 2014;30(7):866–71. doi:10.1016/j.arthro.2014.02.029.

    Article  Google Scholar 

  3. Cheung EV. Chronic lateral elbow instability. Orthop Clin North Am. 2008;39(2):221–8. doi:10.1016/j.ocl.2007.12.007.

    Article  PubMed  Google Scholar 

  4. Charalambous C, Stanley J. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Br. 2008;90-B:272–9. doi:10.1302/0301-620X.90B3.19868.

    Article  Google Scholar 

  5. Dzugan SS, Savoie FH, Field LD, O’Brien MJ, You Z. Acute radial ulno-humeral ligament injury in patients with chronic lateral epicondylitis: an observational report. J Shoulder Elb Surg. 2012;21(12):1651–5. doi:10.1016/j.jse.2012.04.008.

    Article  Google Scholar 

  6. Kalainov D, Cohen M. Posterolateral instability of the elbow in association with lateral epicondylitis: a report of three cases. J Bone Joint Surg. 2005;87:1120–5.

    Article  PubMed  Google Scholar 

  7. Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ. Ligamentous stabilizers against posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 2001;83-A(12):1823–8.

    CAS  PubMed  Google Scholar 

  8. McAdams TR, Masters GW, Srivastava S. The effect of arthroscopic sectioning of the lateral ligament complex of the elbow on posterolateral rotatory stability. J Shoulder Elb Surg. 2005;14(3):298–301. doi:10.1016/j.jse.2004.08.003.

    Article  Google Scholar 

  9. Seki A, Olsen BS, Jensen SL, Eygendaal D, Søjbjerg JO. Functional anatomy of the lateral collateral ligament complex of the elbow: configuration of Y and its role. J Shoulder Elb Surg. 2002;11(1):53–9. doi:10.1067/mse.2002.119389.

    Article  Google Scholar 

  10. Lee ML, Rosenwasser MP. Chronic elbow instability. Orthop Clin North Am. 1999;30(1):81–9. doi:10.1016/S0030-5898(05)70062-6.

    Article  CAS  PubMed  Google Scholar 

  11. O’Driscoll S, Horii E, Morrey BF, Carmichael S. Anatomy of the ulnar part of the lateral collateral ligament of the elbow. Clin Anat. 1992;5:296–303.

    Article  Google Scholar 

  12. Morrey BF, An KN. Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res. 1985;201:84–90. This article is the first description of the lateral ulnar collateral ligament complex.

    PubMed  Google Scholar 

  13. McKee MD, Schemitsch EH, Sala MJ, O’Driscoll SW. The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elb Surg. 2003;12(4):391–6. doi:10.1016/S1058-2746(03)00027-2.

    Article  Google Scholar 

  14. Cohen M, Hastings H. Rotatory instability of the elbow: the anatomy and role of lateral stabilizers. J Bone Joint Surg. 1997;79(2):225–33.

    Article  CAS  PubMed  Google Scholar 

  15. Mehta J, Bain G. Posterolateral instability of the elbow. J Am Acad Orthop Surg. 2004;12:405–15. doi:10.1302/0301-620X.90B3.19868.

    Article  PubMed  Google Scholar 

  16. Goodwin D, Dynin M, MacDonnell JR, Kessler MW. The role of arthroscopy in chronic elbow instability. Arthrosc - J Arthrosc Relat Surg. 2013;29(12):2029–36. doi:10.1016/j.arthro.2013.08.016.

    Article  Google Scholar 

  17. O’Driscoll S, Morrey BF, Korinek S, An KN. Elbow subluxation amd dislocation: a spectrum of instability. Clin Orthop. 1992;280:186–97.

    PubMed  Google Scholar 

  18. Hall JA, McKee MD. Posterolateral rotatory instability of the elbow following radial head resection. J Bone Joint Surg Am. 2005;87(7):1571–9. doi:10.2106/JBJS.D.02829.

    Article  PubMed  Google Scholar 

  19. Anakwenze OA, Kancherla VK, Iyengar J, Ahmad CS, Levine WN. Posterolateral rotatory instability of the elbow. Am J Sports Med. 2013;42(2):485–91. doi:10.1177/0363546513494579. This is a systematic review of the previous literature on LUCL repair and reconstruction for PLRI. As all of the previous studies were smaller patient cohorts, with the largest being 54 patients, this study attempted to combine all the previous patient cohorts to look at the outcomes of repair or reconstruction in a larger patient cohort.

    Article  PubMed  Google Scholar 

  20. Regan W, Lapner PC. Prospective evaluation of two diagnostic apprehension signs for posterolateral instability of the elbow. J Shoulder Elb Surg. 2006;15(3):344–6. doi:10.1016/j.jse.2005.03.009.

    Article  Google Scholar 

  21. Terada N, Yamada H, Toyama Y. The appearance of the lateral ulnar collateral ligament on magnetic resonance imaging. J Shoulder Elb Surg. 2004;13(2):214–6. doi:10.1016/j.jse.2003.12.013.

    Article  Google Scholar 

  22. Beuerlein MJ, Reid JT, Schemitsch EH, McKee MD. Effect of distal humeral varus deformity on strain in the lateral ulnar collateral ligament and ulnohumeral joint stability. J Bone Joint Surg Am. 2004;86-A(10):2235–42.

    PubMed  Google Scholar 

  23. Dowdy PA, Bain GI, King GJ, Patterson SD. The midline posterior elbow incision. An anatomical appraisal. J Bone Joint Surg (Br). 1995;77(5):696–9.

    CAS  Google Scholar 

  24. Kocher T. Text-book of operative surgery. Vol 3rd ed. London: Adam and Charles Black; 1911.

    Google Scholar 

  25. Dürig M, Gauer EF, Müller W. The operative treatment of recurrent and simple traumatic dislocations of the elbow by the method of Osborne and Cotterill (author’s transl). Arch Orthop Unfallchir. 1976;86(2):141–56. doi:10.1007/BF00415327.

    Article  PubMed  Google Scholar 

  26. Savoie FH, Savoie FH, O'Brien MJ, Field LD, Gurley DJ. Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow. Clin Sports Med. 2010;29(4):611–8. doi:10.1016/j.csm.2010.06.008.

    Article  PubMed  Google Scholar 

  27. Nestor B, O’Driscoll S, Morrey B. Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg. 1992;74-A:1235–41. doi:10.1016/S0276-1092(08)70516-9. This article describes the technique and outcomes for the over-lay technique of LUCL reconstruction.

    Google Scholar 

  28. Jones KJ, Dodson CC, Osbahr DC, et al. The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes. J Shoulder Elb Surg. 2012;21(3):389–95. doi:10.1016/j.jse.2011.04.033. This article describes the docking technique often used in LUCL reconstruction. It also discusses the outcomes of the technique.

    Article  Google Scholar 

  29. Sanchez-Sotelo J, Morrey BF, O’Driscoll SW. Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg (Br). 2005;87(1):54–61. doi:10.1016/S0276-1092(08)70516-9. This is the second largest series to date reported to date of the outcomes of PLRI patients with 44 patients undergoing either direct repair or ligamentous reconstruction.

    CAS  Google Scholar 

  30. Lee B, Teo L. Surgical reconstruction for posterolateral rotatory instability of the elbow. J Shoulder Elb Surg. 2003;12(5):476–9. doi:10.1016/S1058-2746(03)00091-0.

    Article  Google Scholar 

  31. Olsen BS, Søjbjerg JO. The treatment of recurrent posterolateral instability of the elbow. J Bone Joint Surg (Br). 2003;85(3):342–6. doi:10.1302/0301-620x.85b3.13669.

    Article  CAS  Google Scholar 

  32. Savoie FH, Field LD, Gurley DJ. Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow. Hand Clin. 2009;25(3):323–9. doi:10.1016/j.hcl.2009.05.010. This is the largest series of PLRI patient outcomes after surgical treatment published to date with 54 patients undergoing either arthroscopic or open reconstruction of the LUCL.

    Article  PubMed  Google Scholar 

  33. Lin KY, Shen PH, Lee CH, Pan RY, Lin LC, Shen HC. Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow. Injury. 2012;43(10):1657–61. doi:10.1016/j.injury.2012.04.023.

    Article  PubMed  Google Scholar 

  34. Eygendaal D. Ligamentous reconstruction around the elbow using triceps tendon. Acta Orthop Scand. 2004;75:516–23.

    Article  PubMed  Google Scholar 

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Correspondence to Luke S. Oh.

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Catherine J. Fedorka and Luke S. Oh declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Elbow Soft Tissue Surgery

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Fedorka, C.J., Oh, L.S. Posterolateral rotatory instability of the elbow. Curr Rev Musculoskelet Med 9, 240–246 (2016). https://doi.org/10.1007/s12178-016-9345-8

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