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Editor's Choice| Volume 48, ISSUE 2, P117-125, February 2023

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Lateral Ulnar Collateral Ligament Repair With Suture-Tape Augmentation for Traumatic Elbow Instability

Published:December 18, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.10.016

      Purpose

      Ligament repair with suture-tape augmentation has been used in the operative treatment of joint instability and may have advantages with respect to early motion and stability. The purpose of this investigation was to describe the clinical results of traumatic elbow instability treated with lateral ulnar collateral ligament repair with suture-tape augmentation.

      Methods

      All cases of acute and chronic elbow instability treated surgically between 2018 and 2020 were included if they underwent ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament as part of the procedure. Cases with <6 months of follow-up were excluded. A manual chart review was performed to record patient demographics as well as injury and surgery characteristics. Radiographic outcomes, range of motion, and patient-reported outcome measures, including the visual analog pain scale and Disabilities of the Arm, Shoulder, and Hand, were recorded. Range of motion measurements were recorded at the end of the clinical follow-up, as were surgical complications.

      Results

      Eighteen cases were included with a mean follow-up of 20 months. Five (28%) cases involved a high-energy mechanism, and 11 (62%) cases involved terrible triad fracture dislocations. The mean Disabilities of the Arm, Shoulder, and Hand questionnaire and visual analog pain scale scores were 17 and 2, respectively. The mean flexion-extension arc was 124°, and 2 (11%) cases had <100° flexion-extension arc. There were 2 (11%) postoperative complications, and both cases had postoperative instability requiring reoperation. We observed no cases of capitellar erosion from the suture-tape material.

      Conclusions

      For complex elbow instability, ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in acceptable functional outcomes and a reoperation rate comparable with other joint stabilization procedures.

      Type of study/level of evidence

      Therapeutic IV.

      Key words

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      References

        • O’Driscoll S.
        • Bell D.
        • Morrey B.F.
        Posterolateral instability of the elbow.
        J Bone Joint Surg Am. 1991; 73: 440-446
        • Stoneback J.W.
        • Owens B.D.
        • Sykes J.
        • Athwal G.S.
        • Pointer L.
        • Wolf J.M.
        Incidence of elbow dislocations in the United States population.
        J Bone Joint Surg Am. 2012; 94: 240-245
        • Seki A.
        • Olsen B.S.
        • Jensen S.L.
        • Eygendaal D.
        • Søjbjerg J.O.
        Functional anatomy of the lateral collateral ligament complex of the elbow: configuration of Y and its role.
        J Shoulder Elbow Surg. 2002; 11: 53-59
        • Dunning C.E.
        • Zarzour Z.D.
        • Patterson S.D.
        • Johnson J.A.
        • King G.J.
        Ligamentous stabilizers against posterolateral rotatory instability of the elbow.
        J Bone Joint Surg Am. 2001; 83: 1823-1828
        • McAdams T.R.
        • Masters G.W.
        • Srivastava S.
        The effect of arthroscopic sectioning of the lateral ligament complex of the elbow on posterolateral rotatory stability.
        J Shoulder Elbow Surg. 2005; 14: 298-301
        • Anakwenze O.A.
        • Kancherla V.K.
        • Iyengar J.
        • Ahmad C.S.
        • Levine W.N.
        Posterolateral rotatory instability of the elbow.
        Am J Sports Med. 2014; 42: 485-491
        • Dzugan S.S.
        • Savoie III, F.H.
        • Field L.D.
        • O’Brien M.J.
        • You Z.
        Acute radial ulno-humeral ligament injury in patients with chronic lateral epicondylitis: an observational report.
        J Shoulder Elbow Surg. 2012; 21: 1651-1655
        • Charalambous C.P.
        • Stanley J.K.
        Posterolateral rotatory instability of the elbow.
        J Bone Joint Surg Br. 2008; 90: 272-279
        • Pugh D.M.
        • McKee M.D.
        The “terrible triad” of the elbow.
        Tech Hand Up Extrem Surg. 2002; 6: 21-29
        • Stambulic T.
        • Desai V.
        • Bicknell R.
        • Daneshvar P.
        Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping review.
        JSES Rev Rep Tech. 2022; 2: 214-218
        • Kaneshiro Y.
        • Yano K.
        • Yokoi T.
        • Sakanaka H.
        • Fukuda M.
        • Hidaka N.
        Is repair of a small coronoid fracture required in the surgical treatment of terrible triad injury of the elbow?.
        J Hand Surg Asian Pac Vol. 2022; 27: 345-351
        • Papatheodorou L.K.
        • Rubright J.H.
        • Heim K.A.
        • Weiser R.W.
        • Sotereanos D.G.
        Terrible triad injuries of the elbow: does the coronoid always need to be fixed?.
        Clin Orthop Relat Res. 2014; 472: 2084-2091
        • Ring D.
        • Bruinsma W.E.
        • Jupiter J.B.
        Complications of hinged external fixation compared with cross-pinning of the elbow for acute and subacute instability.
        Clin Orthop Relat Res. 2014; 472: 2044-2048
        • De Giorgi S.
        • Vicenti G.
        • Bizzoca D.
        • et al.
        Lateral collateral ulnar ligament reconstruction techniques in posterolateral rotatory instability of the elbow: a systematic review.
        Injury. 2022; 53: S8-S12
        • Yu J.R.
        • Throckmorton T.W.
        • Bauer R.M.
        • Watson J.T.
        • Weikert D.R.
        Management of acute complex instability of the elbow with hinged external fixation.
        J Shoulder Elbow Surg. 2007; 16: 60-67
        • Chen N.C.
        • Julka A.
        Hinged external fixation of the elbow.
        Hand Clin. 2010; 26: 423-433, vii
        • Sochol K.M.
        • Andelman S.M.
        • Koehler S.M.
        • Hausman M.R.
        Treatment of traumatic elbow instability with an internal joint stabilizer.
        J Hand Surg Am. 2019; 44: 161.e1-161.e7
        • Orbay J.L.
        • Ring D.
        • Kachooei A.R.
        • et al.
        Multicenter trial of an internal joint stabilizer for the elbow.
        J Shoulder Elbow Surg. 2017; 26: 125-132
        • Pasternack J.B.
        • Ciminero M.L.
        • Choueka J.
        • Kang K.K.
        Patient outcomes for the internal joint stabilizer of the elbow (IJS-E).
        J Shoulder Elbow Surg. 2020; 29: e238-e244
        • Jain N.P.
        • Ayyaswamy B.
        • Griffiths A.
        • Alderton E.
        • Kostusiak M.
        • Limaye R.V.
        Is internal brace augmentation a gold standard treatment compared to isolated Modified Brostrom Gould repair for chronic lateral ligament ankle instability? Effect on functional outcome and return to preinjury activity: a retrospective analysis.
        Foot (Edinb). 2022; 50: 101865
        • Wilson W.T.
        • Hopper G.P.
        • Banger M.S.
        • Blyth M.J.G.
        • Riches P.E.
        • MacKay G.M.
        Anterior cruciate ligament repair with internal brace augmentation: a systematic review.
        Knee. 2022; 35: 192-200
        • Dugas J.R.
        • Looze C.A.
        • Capogna B.
        • et al.
        Ulnar collateral ligament repair with collagen-dipped fibertape augmentation in overhead-throwing athletes.
        Am J Sports Med. 2019; 47 (Published correction appears in Am J Sports Med. 2019 Jun;47(7):NP40): 1096-1102
        • O’Connell R.
        • Hoof M.
        • Heffernan J.
        • O’Brien M.
        • Savoie F.
        Medial ulnar collateral ligament repair with internal brace augmentation: results in 40 consecutive patients.
        Orthop J Sports Med. 2021; 9 (23259671211014230)
        • Gehrman M.D.
        • Grandizio L.C.
        Elbow ulnar collateral ligament injuries in throwing athletes: diagnosis and management.
        J Hand Surg Am. 2022; 47: 266-273
        • Scheiderer B.
        • Imhoff F.B.
        • Kia C.
        • et al.
        LUCL internal bracing restores posterolateral rotatory stability of the elbow.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 1195-1201
        • Melbourne C.
        • Cook J.L.
        • Della Rocca G.J.
        • Loftis C.
        • Konicek J.
        • Smith M.J.
        Biomechanical assessment of lateral ulnar collateral ligament repair and reconstruction with or without internal brace augmentation.
        JSES Int. 2020; 4: 224-230
        • Ellwein A.
        • Stryga M.
        • Ferle M.
        • Pastor M.F.
        • Lill H.
        • Smith T.
        Biomechanical comparison of two fixation techniques for lateral ulnar collateral ligament repair with ligament bracing.
        J Hand Surg Am. 2022; 47: 1016.e1-1016.e8
        • Greiner S.
        • Koch M.
        • Kerschbaum M.
        • Bhide P.P.
        Repair and augmentation of the lateral collateral ligament complex using internal bracing in dislocations and fracture dislocations of the elbow restores stability and allows early rehabilitation.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3269-3275
        • Regan W.
        • Morrey B.
        Fractures of the coronoid process of the ulna.
        J Bone Joint Surg Am. 1989; 71: 1348-1354
        • Broberg M.A.
        • Morrey B.F.
        Results of treatment of fracture-dislocations of the elbow.
        Clin Orthop Relat Res. 1987; 216: 109-119
        • Hastings II, H.
        • Graham T.J.
        The classification and treatment of heterotopic ossification about the elbow and forearm.
        Hand Clin. 1994; 10: 417-437
        • Amini M.H.
        • Sykes J.B.
        • Olson S.T.
        • Smith R.A.
        • Mauck B.M.
        • Azar F.M.
        • et al.
        Reliability testing of two classification systems for osteoarthritis and post-traumatic arthritis of the elbow.
        J Shoulder Elbow Surg. 2015; 24: 353-357
        • Camp C.L.
        • Sanchez-Sotelo J.
        • Shields M.N.
        • O’Driscoll S.W.
        Lateral ulnar collateral ligament reconstruction for posterolateral rotatory instability of the elbow.
        Arthrosc Tech. 2017; 6: e1101-e1105
        • Desai M.J.
        • Matson A.P.
        • Ruch D.S.
        • Leversedge F.J.
        • Aldridge III, J.M.
        • Richard M.J.
        Perioperative glucocorticoid administration improves elbow motion in terrible triad injuries.
        J Hand Surg Am. 2017; 42: 41-46
        • Giannicola G.
        • Calella P.
        • Piccioli A.
        • Scacchi M.
        • Gumina S.
        Terrible triad of the elbow: is it still a troublesome injury?.
        Injury. 2015; 46: S68-S76
        • Domos P.
        • Griffiths E.
        • White A.
        Outcomes following surgical management of complex terrible triad injuries of the elbow: a single surgeon case series.
        Shoulder Elbow. 2018; 10: 216-222
        • Zhang C.
        • Zhong B.
        • Luo C.F.
        Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People’s Hospital.
        Injury. 2014; 45: 942-948
        • Fitzgibbons P.G.
        • Louie D.
        • Dyer G.S.
        • Blazar P.
        • Earp B.
        Functional outcomes after fixation of “terrible triad” elbow fracture dislocations.
        Orthopedics. 2014; 37: e373-e376
        • Pizzoli A.
        • Bondi M.
        • Schirru L.
        • Bortolazzi R.
        The use of articulated external fixation for complex elbow trauma treatment.
        Musculoskelet Surg. 2021; 105: 75-87
        • Sanchez-Sotelo J.
        • Morrey B.F.
        • O’Driscoll S.W.
        Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow.
        J Bone Joint Surg Br. 2005; 87: 54-61
        • Rothermich M.A.
        • Fleisig G.S.
        • Lucas H.E.
        • et al.
        Early complications of ulnar collateral ligament repair with collagen-coated suture tape augmentation.
        Orthop J Sports Med. 2021; 9 (23259671211038320)
        • Chen H.W.
        • Liu G.D.
        • Wu L.J.
        Complications of treating terrible triad injury of the elbow: a systematic review.
        PLoS One. 2014; 9: e97476
        • Cramer K.E.
        • Moed B.R.
        • Karges D.E.
        • Watson J.T.
        Unstable elbow dislocations and fracture-dislocations: temporary transarticular fixation.
        J Orthop Trauma. 2000; 14: 120
        • Iordens G.I.
        • Den Hartog D.
        • Van Lieshout E.M.
        • et al.
        Good functional recovery of complex elbow dislocations treated with hinged external fixation: a multicenter prospective study.
        Clin Orthop Relat Res. 2015; 473: 1451-1461
        • Cheung E.V.
        • O’Driscoll S.W.
        • Morrey B.F.
        Complications of hinged external fixators of the elbow.
        J Shoulder Elbow Surg. 2008; 17: 447-453