Lateral ulnar collateral ligament reconstruction enhancing secondary stabilizers in chronic PLRI of the elbow provides good to excellent clinical results with no recurrent instability

Nikolay Dimitrov; Tsvetan Tsenkov

doi:10.1016/j.jos.2023.11.013

Lateral ulnar collateral ligament reconstruction enhancing secondary stabilizers in chronic PLRI of the elbow provides good to excellent clinical results with no recurrent instability

J Orthop Sci. 2023 Dec 2:S0949-2658(23)00327-5. doi: 10.1016/j.jos.2023.11.013. Online ahead of print.

Authors

Nikolay Dimitrov¹, Tsvetan Tsenkov²

Affiliations

¹ University Hospital of Orthopaedics "Prof. B. Boichev", Medical University of Sofia, Sofia, Bulgaria.
² University Hospital of Orthopaedics "Prof. B. Boichev", Medical University of Sofia, Sofia, Bulgaria. Electronic address: tsvetan.tsenkov@icloud.com.

PMID: 38044214
DOI: 10.1016/j.jos.2023.11.013

Abstract

Purpose: The adopted treatment for chronic elbow PLRI is lateral ulnar collateral ligament reconstruction. However, the most frequently reported complication after primary reconstruction is recurrent instability - up to 25 %. It was thus hypothesized that enhancing the secondary stabilizers will provide successful results with a lower rate of recurrent instability in comparison to techniques with primary reconstruction only. This study aimed to demonstrate a novel surgical technique involving secondary stabilizers.

Methods: In this retrospective study of 29 cases with chronic PLRI the mean duration of symptoms was 39.6 ± 4.9 months. The mean age was 47.9 years with mainly male patients. The surgeries were performed by one senior surgeon at a single institution. The Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) were recorded.

Results: The mean follow-up was 36.8 ± 7.7 months. The MEPS score improved significantly from 59.8 ± 13.1 to 84.7 ± 7.6 (p < 0.001). 23/29 patients (79.2 %) had converted to good and excellent results (MEPS >75 points). The DASH score improved from 40.8 ± 4.6 to 20.9 ± 7.2 (p < 0.001). The total complication rate was 10.3 % (N = 3). No recurrent instability was recorded in comparison to 12.2 % for primary reconstruction only, as reported in the literature (p < 0.05).

Conclusion: Enhancing the secondary stabilizers by utilizing an adjacently located autograft provided good and excellent results with no recurrent instability. This novel surgical procedure is easy to reproduce and provides a safe and reliable alternative in cases of chronic PLRI when compared to techniques with primary reconstruction only.

Keywords: Elbow; Elbow instability; LUCL; PLRI; Secondary stabilizers; Triceps tendon autograft.