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. 2022 Dec;142(12):3837-3844.
doi: 10.1007/s00402-021-04276-2. Epub 2022 Jan 6.

Prospective clinical results of an additive ligament bracing for stabilizing simple and complex elbow instabilities

Alexander Ellwein  1   2 , Larissa Janning  3 , Rony-Orijit DeyHazra  3 , Tomas Smith  4 , Helmut Lill  3 , Gunnar Jensen  3
Affiliations

Prospective clinical results of an additive ligament bracing for stabilizing simple and complex elbow instabilities

Alexander Ellwein et al. Arch Orthop Trauma Surg. 2022 Dec.

Abstract

Introduction: Ligament bracing augments ligament repair using a non-absorbable suture tape. Although biomechanically an increase in primary stability has been proven, there is a lack of clinical evidence. Purpose of this study was to evaluate clinical results of patients treated with ligament bracing due to primary elbow instability, including an analysis of complications. Furthermore, clinical results for patients treated with and without early functional mobilization were compared.

Materials and methods: This prospective case-series evaluated clinical and functional results from patients treated with ligament bracing due to primary elbow instability. Clinical outcome measures were range of motion (ROM) as well as objective and subjective elbow scores [Mayo Elbow Performance Score (MEPS); Disabilities of Arm, Shoulder and Hand Score (DASH score)]. Stability was evaluated sonographically by humero-radial gapping under varus stress.

Results: This study involved 34 patients treated with ligament bracing. After a mean follow-up of 12.9 months ROM was 112° ± 29, MEPS 88 ± 13 points, DASH 91 ± 11 points, and 84% were satisfied with their result. Lateral joint gapping was 2.4 mm. No significant difference was observed regarding a postoperative mobilization with and without limitations. Most common complication after ligament bracing was elbow stiffness including heterotopic ossifications in four patients (12%).

Conclusion: Operatively treated elbow instability with additional ligament bracing results in good clinical outcomes with high patient satisfaction and recovery of elbow stability. The high primary stability of the ligament bracing allows early functional mobilization without bracing, which facilitates postoperative rehabilitation. Elbow stiffness with heterotopic ossification seems to be a potential complication. Furthermore, the optimal tensioning of the ligament bracing remains challenging, including the risk of an over tensioning.

Level of evidence: III.

Keywords: Augmentation; Elbow dislocation; LUCL; MCL; Posterolateral rotatory instability.

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