Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability After Failed Common Extensor...

Area of Science:

• Orthopedic surgery
• Elbow instability
• Sports medicine

Background:

• Chronic lateral epicondylitis often fails nonoperative treatment, leading to common extensor origin (CEO) release surgery.
• CEO release can cause iatrogenic lateral ulnar collateral ligament (LUCL) injuries, resulting in posterolateral rotatory instability (PLRI).
• Revision surgery is sometimes necessary to address PLRI following CEO release.

Purpose of the Study:

• To evaluate the clinical outcomes of lateral ulnar collateral ligament (LUCL) reconstruction using a triceps tendon graft.
• To assess the effectiveness of LUCL reconstruction specifically in patients with PLRI after failed open CEO surgery.

Main Methods:

• A case series of 103 patients who underwent revision surgery for PLRI after CEO release (Hohmann procedure).
• 72 patients were available for follow-up at a minimum of 2 years post-LUCL reconstruction.
• Outcomes were assessed using the Mayo Elbow Performance Score (MEPS), QuickDASH, subjective elbow value (SEV), and patient satisfaction.

Main Results:

• Mean follow-up was 2.8 years; mean MEPS was 78.9, and mean QuickDASH score was 20.4.
• 75% of patients reported good to excellent outcomes, with a mean SEV of 78.6%.
• Complications occurred in 14% of patients, with 9 requiring revision surgery, primarily due to graft failure and recurrent instability.

Conclusions:

• LUCL reconstruction effectively restores elbow stability and achieves high patient satisfaction in cases of PLRI post-CEO release.
• However, the outcome scores and revision rates in this cohort were inferior compared to primary LUCL reconstructions for non-iatrogenic PLRI.
• This suggests that while LUCL reconstruction is a viable option, outcomes may be compromised in revision settings after CEO release.