Posterolateral Rotatory Instability of the Elbow: A Practice-Focused Narrative Review

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Elbow Biomechanics

Background:

• Posterolateral rotatory instability (PLRI) is the most frequent elbow instability pattern.
• It is frequently underdiagnosed due to normal radiographs and dynamic instability.
• PLRI can be a significant cause of persistent lateral elbow pain.

Purpose of the Study:

• To synthesize current evidence on the lateral collateral ligament (LCL) complex, focusing on the lateral ulnar collateral ligament (LUCL).
• To integrate anatomy, pathomechanics, clinical presentation, examination, imaging, and management of PLRI.
• To provide practical diagnostic and treatment pathways for PLRI.

Main Methods:

• Narrative review of peer-reviewed literature from PubMed and MEDLINE.
• Focus on seminal and contemporary articles regarding LUCL and PLRI.
• Integration of applied anatomy, biomechanics, clinical findings, and management strategies.

Main Results:

• Diagnosis is primarily clinical, supported by provocative testing and imaging (radiographs, CT, MRI, fluoroscopy, ultrasound).
• Conservative management includes activity modification, physiotherapy, and bracing for low-grade cases.
• Surgical treatment involves anatomic LUCL reconstruction, with good-to-excellent outcomes (85-90%) reported in contemporary series.

Conclusions:

• Early recognition and intervention are crucial for functional recovery and reducing recurrent instability.
• Structured rehabilitation is key for high return-to-activity rates.
• Deformity-driven cases (e.g., cubitus varus) require special considerations, potentially including corrective osteotomy.