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. 2024 Mar 20;4(3):485-492.
doi: 10.1016/j.xrrt.2024.02.008. eCollection 2024 Aug.

Interposition arthroplasty and bidirectional stabilization of the elbow: a novel surgical technique

Jeffrey S Chen  1 , Emerald D Robertson  1 , Alexandria A Bosetti  1 , Colin H Beckwitt  1 , Mark E Baratz  1 , Robert A Kaufmann  1
Affiliations

Interposition arthroplasty and bidirectional stabilization of the elbow: a novel surgical technique

Jeffrey S Chen et al. JSES Rev Rep Tech. .
No abstract available

Keywords: Arthritis; Collateral ligaments; Elbow; Instability; Interposition arthroplasty; Ligament reconstruction.

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Figures

Figure 1
Figure 1
(A) A drill guide is employed to facilitate accurate drill hole placement in the proximal ulna. (B) The ulnar plates and associated bolts and splined nuts are placed but not fully tightened until subsequent ligament graft placement.
Figure 2
Figure 2
Bony landmarks are used to identify the centerline of ulnohumeral rotation. Two K-wires are drilled along this centerline position from medial and lateral sides. The side holes of the drill guide allow for placement of a second parallel K-wire to accommodate for the radius of the cannulated drill bit.
Figure 3
Figure 3
Two strips of allograft (3.5-4 mm in diameter) are harvested to obtain the ligament grafts. The grafts are tested by passing them through the cylindrical ligament retention device (CLRD) eyelets to ensure free passage. The interposition graft is draped over the distal humerus to make sure it is of adequate size. DIA, diameter.
Figure 4
Figure 4
(A) The distal humerus articular surface is prepared with a burr and/or rongeurs with care to preserve subchondral bone. (B) Four drill holes are placed in the distal humerus 1 cm proximal to the olecranon fossa. (C) Two additional drill holes are made within the olecranon fossa.
Figure 5
Figure 5
(A) The interposition graft is secured with three locking horizontal mattress sutures. (B) The graft is draped over the distal humerus and sutures separated as shown. (C) Using a suture passer, the medial-most suture limb is passed from posterior to anterior through the medial-most bone tunnel. (D) The next two suture limbs are passed through the second bone tunnel. (E) The following two suture limbs are passed through the third bone tunnel. (F) The lateral-most suture limb is passed through the fourth bone tunnel.
Figure 6
Figure 6
(A) A suture is placed to match the olecranon fossa holes. (B) The suture limbs are ready to be retrieved. (C) Using a suture passer, the medial-most suture limb is passed from posterior to anterior through the medial fossa hole. (D) The next suture limb is passed through the second bone tunnel. (E) Both suture limbs have been passed. (F) The interposition graft is flipped over the distal humerus articular surface.
Figure 7
Figure 7
(A) All suture limbs have been passed through the distal humerus. (B) A free needle is used to pass the lateral olecranon fossa suture through the interposition graft. (C) The medial olecranon fossa suture is passed through the graft.
Figure 8
Figure 8
(A) A free needle is used to pass the single lateral suture through the interposition graft. (B) The lateral paired sutures are passed through the graft. (C) The medial paired sutures are passed through the graft. (D) The single medial suture is passed through the graft. (E) All sutures have been passed through the graft and are ready to be tied. (F) The interposition graft is tied and secured to bone.
Figure 9
Figure 9
(A) With ligament grafts loaded into the eyelets, the CLRD is placed through the distal humerus. (B) After the elbow is reduced and the ligament grafts are tensioned, the grafts are secured to the bone by tightening the nuts on the trans-ulnar bolts. CLRD, cylindrical ligament retention device.
Figure 10
Figure 10
(A) The trans-ulnar bolts are cut to reduce hardware prominence. (B) A hole can be drilled in the medial epicondyle for extra graft security. (C) A needle and suture are passed through the bone bridge. (D) The suture is passed through the limbs of the reconstructed ligaments. (E) The suture is passed through the confluence of the FCU and native collateral ligaments. (F) Additional sutures are placed to secure the medial soft tissues. This process is repeated in a similar fashion on the lateral aspect of the elbow. FCU, flexor carpi ulnaris.
Figure 11
Figure 11
(A) The FCU and ECU are repaired over the proximal ulnar plates. (B) Soft tissue closure incorporates the remnant native collateral ligaments, which were left in continuity with the common extensor and flexor-pronator masses. FCU, flexor carpi ulnaris; ECU, extensor carpi ulnaris.
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