Effectiveness of an All-arthroscopic Procedure for Terrible Triad Injuries at 5-Year Follow-up

This study evaluated the clinical and radiologic results of allarthroscopic treatment of terrible triad of the elbow over a minimum of 5 years.

We retrospectively reviewed consecutive patients with terrible triad injury who underwent all-arthroscopic surgery between January 2011 and June 2018. We performed all-arthroscopic treatment for these patients, excluding those with a Regan-Morrey type III coronoid process fracture, involvement of the anteromedial facet, or a radial head fracture involving >50% of the articular surface. Elbow stability, range of motion, Mayo Elbow Performance Score, and radiologic outcomes were assessed at least 5 years postoperatively.

Thirty-two patients met the inclusion criteria, and mean age was 49.5±15.9 years. At a mean follow-up of 6.9±1.8 years, mean arc of flexion for the affected elbow was 7.1°±7.4° to 132.4°±10.0°. Mean visual analog scale and Mayo Elbow Performance Score were 1.4±0.6 and 91±15.7 points, respectively. Clinical scores and range of motion showed no significant differences between the affected and contralateral elbows. Nonunion of the coronoid process occurred in 4 cases, but none led to instability or required reoperation. Heterotopic ossification was observed for 15 patients (47%), grade 1 arthritis for 7 patients (22%), and grade 3 arthritis for 3 patients (9%), but none progressed to joint stiffness or required reoperation. Two complications required reoperation: 1 case of pin site irritation that resolved after pin removal and 1 case of worsening arthritic degeneration leading to total elbow arthroplasty at 5-year follow-up. No other complications, such as infection or neurovascular injury, were observed.

In terrible triad elbow injuries, all-arthroscopic treatment restores elbow joint stability and achieves good clinical and radiologic outcomes compared with open treatment. We recommend this procedure as a treatment option for patients if the indications are met, such as Regan-Morrey type I or II coronoid process fractures and radial head fractures involving <50% of the articular surface. [Orthopedics. 2025;48(3):e131-e138.].