Soft tissue constraint injuries in complex elbow instability: surgical techniques and clinical outcomes

The surgical procedures for and outcomes of soft tissue constraint reconstruction in complex elbow instability have been rarely investigated. The purpose of this study was to analyze the clinical outcomes in a series of patients with complex elbow instability in whom the associated soft tissue constraint injures were identified and treated based on the pathoanatomic changes found intraoperatively. Forty-five patients (23 men and 22 women; mean age, 54 years) with complex elbow instability were followed prospectively. Surgical treatment included the anatomic reduction and internal fixation of any fracture and radial head replacement in Mason type III injuries. Soft tissue constraint lesions were then repaired based on the type of lesion (eg, proximal or distal ligament avulsion, middle-zone lesion, or presence of detached bony fragments). Posterolateral capsular lesions and common extensor and flexor origin injuries were also repaired. Patients were followed clinically and radiographically after a mean of 25 months. Functional range of motion was achieved in 39 (86%) patients. Average Mayo Elbow Performance Score; Disabilities of the Arm, Shoulder and Hand score; and American Shoulder and Elbow Surgeons shoulder score were 94, 5.6, and 89, respectively. At last follow-up, 42 (93%) patients showed no evidence of elbow instability, 2 (4%) patients had mild varus instability, and 1 (2%) patient had moderate posterolateral instability. The accurate identification of pathoanatomic changes of elbow soft tissue constraint lesions associated with complex elbow instability is an essential prerequisite to planning proper surgical treatment. The results of this study show that, in patients with complex elbow instability, once the fracture has been treated and each type of soft tissue constraint lesion adequately repaired, a high percentage of satisfactory functional outcomes may be achieved.