Radial head replacement with intact lateral ulnar collateral ligament vs. repair and augmentation using nonabsorbable...

Rupture of the lateral ulnar collateral ligament (LUCL), particularly in cases of complex radial head fractures, can occur in up to 80% of cases. The outcomes of radial head replacement in such scenarios may not be optimal despite ligament augmentation. The objective was to compare the clinical outcomes of radial head replacement in elbows with an intact LUCL to those with a complete LUCL rupture managed with repair and augmentation.

From January 2021 to June 2023, 27 patients underwent radial head replacement surgery using the Antea modular mobile radial head prosthesis (Adler Ortho). The patients were divided into 2 groups: 15 without rupture of the LUCL ligament (group A) and 12 with rupture (group B), in whom the ligament was repaired and augmented using non absorbable tape and anchors. Patients with other associated ligament injuries or fractures were excluded. Post-operative outcomes were assessed using the Mayo Elbow Performance Score (MEPS), the visual analog scale (VAS), and the range of motion (ROM) of the elbow. Follow-up assessments were conducted at 6, 12, 24, and 52 weeks postsurgery, and all patients completed the planned 52-week follow-up. Statistical analysis was performed using the Mann-Whitney U test.

At 12 weeks, the flexion-extension arc was significantly greater in group A compared with group B (median 122° vs. 113.5°, P = .02), corresponding clinically to median ROM of 10°-132° vs. 15°-126°. At 6, 24 and 52 weeks, there were no statistically significant differences in ROM between groups, although a mild residual extension deficit persisted in group B at 1 year (0°-137° vs. 7.5°-136°, P = .06). Final MEPS and VAS scores were comparable, with median MEPS of 100 and 95 (P = .18) and median VAS of 1.0 and 1.5 (P = .24) in groups A and B respectively.

The results of radial head replacement, even in cases with LUCL tear and LUCL repair and augmentation are satisfactory, particularly from the third month onward. In cases of augmentation, a residual extension deficit of the elbow was observed; however, it did not cause functional impairment as measured by the MEPS.