Elbow instability: treatment strategies and emerging concepts

Elbow stability relies on a complex interaction between the bony articulations of the elbow joint, the capsuloligamentous structures, and dynamic muscle restraints. Understanding the functional anatomy of the elbow and the relative contribution of the various elements to elbow stability is important in developing a strategy for diagnosis and management. Elbow instability presents a spectrum from minor subluxation to dislocation. The treatment of an acute dislocation is determined by the stability of the elbow after reduction and the fixation of associated fractures. Isolated acute tears of the LCL are uncommon and are generally treated nonsurgically. On the medial side, augmented repair is required for return to throwing sports. Chronic MCL insufficiency results in valgus instability, which usually is a problem only for the throwing athlete. Chronic LCL insufficiency may lead to symptomatic posterolateral joint subluxation. Free tendon graft reconstruction can be successful on both sides of the joint, with a return of stability and improved elbow function.