Repair Versus Non-Repair of Lateral Ulnar Collateral Ligament in Elbow Varus Posteromedial Rotatory Instability Treatment: A Comparative Study

Abstract

Objective: To compare the effects of repairing and not repairing the lateral ulnar collateral ligament (LUCL) when surgically treating elbow varus posteromedial rotatory instability (PMRI).

Methods: In this retrospective study spanning June 2014 to February 2019, 24 patients with elbow PMRI who were treated surgically were assigned to group RL (Repair LUCL) or group NL (Non-repair LUCL) depending on whether the LUCL was repaired. Hospitalization time, operation time, intraoperative blood loss, and related complications were reviewed. The elbow range of motion (ROM), the visual analog scale (VAS), the Mayo elbow performance score (MEPS), and the disabilities of the arm, shoulder, and hand (DASH) score were used for functional assessment.

Results: Among the 24 patients with PMRI, 15 were assigned to group RL and nine were assigned to group NL. The mean blood loss (184.66 ± 20.3 vs 207.33 ± 19.447, P < 0.001), the operation time (98.88 ± 12.693 min vs 184.66 ± 20.3 min, P < 0.001) were significantly lower in group RL compared to group NL. There were no significant differences between the two groups in time until surgery and follow-up time (6.66 ± 1.838 vs 6.11 ± 1.900 days, 25.53 ± 2.099 vs 26.11 ± 2.891 months, P = 0.577, P = 0.486). All of the patients achieved bone union. The elbow flexion-extension ROM (122.00° ± 3.162°vs 121.11° ± 3.333° at 12 months, P = 0.520) and pronation-supination ROM (154.53° ± 3.335° vs 155.55° ± 4.639° at 12 months, P = 0.537). Both groups achieved similar results in MEPS score (90.53 ± 2.695 vs 89.77 ± 3.865, P = 0.578) and DASH (9.77 ± 1.897 vs 9.99 ± 1.550, P = 0.772) score at the final follow-up. And the MEPS score revealed excellent results (87% in group RL, 89% in group NL).The VAS scores decreased significantly in group RL (from 6.13 ± 0.990 to 1.93 ± 0.593) and group NL (from 5.77 ± 1.481 to 1.88 ± 0.781), and no significant differences in preoperative or final follow-up were observed between the two groups (P = 0.487, P = 0.876). Complications observed in group NL with one patient occurred cubital tunnel syndrome 3 months after the operation, the patient underwent ulnar nerve simple neurolysis and the symptoms were relieved after 3 weeks.

Conclusion: For patients with elbow PMRI, satisfactory functional outcomes can be yielded with non-repair of the LUCL as long as the stable elbow joint is performed during operation.

Keywords: Elbow instability; LUCL; Lateral ulnar collateral ligament; PMRI; Varus posteromedial rotatory instability.

Fig 1

Schematic drawings for the surgical technique. (A) Surgical diagram of group NL with reconstruct the anteromedial facet coronoid fracture. (B) Surgical diagram of group RL with reconstruct the anteromedial facet coronoid fracture and repair of the lateral ulnar collateral ligament.

Fig 2

A 35‐year‐old male who had a left elbow varus posteromedial rotatory instability (PMRI) due to a bad fall. (A, B) The preoperative antero‐posterior and lateral X‐rays showed a anteromedial facet coronoid fracture. (C) The anteromedial facet coronoid fractures were shown in 3D reconstruction. (D) The magnetic resonance imaging (MRI) revealed complete rupture of the lateral ulnar collateral ligament (LUCL). (E) The coronoid fractures were treated with a screw fixation and the intraoperative antero‐posterior X‐ray showing equal space between the medial and lateral joint space. (F) The intraoperative lateral X‐ray was taken in the extension‐supination position and showed no subluxation or dislocation in the elbow joint. (G, H) The antero‐posterior and lateral X‐ray of the elbow at postoperative 26 months. (I, J) The appearance of the elbow pronation and supination at postoperative 26 months. (K, L) The appearance of the elbow flexion and extension at postoperative 26 months.

Fig 3

A 52‐year‐old male who had a right elbow varus posteromedial rotatory instability (PMRI) due to a traffic accident. (A) The preoperative lateral X‐ray demonstrated subluxation of elbow joint. (B) The preoperative antero‐posterior X‐ray showed anteromedial facet coronoid fractures and humeral lateral epicondylar avulsion fractures. (C, D, E) The anteromedial facet coronoid fracture and humeral lateral epicondylar avulsion fractures were shown on computed tomography (CT) and 3D reconstruction. (F) The coronoid fractures and humeral lateral epicondylar avulsion fractures were treated with suture anchor fixation and the intraoperative antero‐posterior X‐ray showing equal space between the medial and lateral joint space. (G) The intraoperative lateral X‐ray was taken in the extension‐supination position and showed no subluxation or dislocation in the elbow joint. (H, I) The antero‐posterior and lateral X‐ray of the elbow at postoperative 24 months. (J, K) The appearance of the elbow pronation and supination at postoperative 24 months. (L, M) The appearance of the elbow flexion and extension at postoperative 24 months.