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Dual Ligament Reconstruction in a Neglected Medio-Lateral Instability of the Elbow: A Case Report and Surgical
Vineet Thomas Abraham1, Kalyan Deepak Sreenivas1, Muni Srikanth Iytha1
1Department of Orthopaedics, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India.
Introduction:
Injuries around the elbow can cause medial, lateral, or combined mediolateral instability. Surgical intervention is often required in cases of lateral instability, with lateral ulnar collateral ligament reconstruction being the preferred treatment. Medial instability is frequently seen in sports involving throwing, such as baseball and American football. In elite athletes, ligament reconstruction is preferred over conservative treatment or ligament repair to facilitate a faster return to professional sports. Combined medial and lateral ligament injuries are rare but need early repair or reconstruction. These injuries, when left untreated, can cause chronic disability and early-onset arthritis.
Case Report:
A 37-year-old patient presented with an injury 2 years ago. She was having persistent elbow pain affecting daily activities. MRI revealed a LUCL and UCL tear. We performed LUCL reconstruction using the triceps autograft and MUCL reconstruction using the PL autograft using the docking technique. Patient's elbow function improved from Mayo's elbow performance index of poor (40) to good (85).
Conclusion:
Mediolateral instability can be treated with reconstruction of both the LUCL and UCL using tendon grafts via the docking technique, even in neglected cases, thereby achieving a good functional outcome.