Clin Orthop Surg.  2015 Jun;7(2):241-247. 10.4055/cios.2015.7.2.241.

Unstable Simple Elbow Dislocation Treated with the Repair of Lateral Collateral Ligament Complex

• Heo YM
• Yi JW
• Lee JB
• Lee DH
• Park WK
• Kim SJ

• KMID: 2164551
• DOI: http://doi.org/10.4055/cios.2015.7.2.241

Abstract

BACKGROUND
Unstable simple elbow dislocation (USED) repair is challenged by the maintenance of joint reduction; hence, primary repair or reconstruction of disrupted ligaments is required to maintain the congruency and allow early motion of the elbow. We evaluated the effectiveness and the outcome of lateral collateral ligament (LCL) complex repair with additional medial collateral ligament (MCL) repair in cases of USED.
METHODS
We retrospectively reviewed 21 cases of diagnosed USED without fractures around the elbow that were treated with primary ligament repair. In all cases, anatomical repair of LCL complex with or without common extensor origin was performed using suture anchor and the bone tunnel method. Next, the instability and congruency of elbow for a full range of motion were evaluated under the image intensifier. MCL was repaired only if unstable or incongruent elbow was observed. Clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and radiographic outcomes on last follow-up images.
RESULTS
All cases achieved a stable elbow on radiographic and clinical results. LCL complex repair alone was sufficient to obtain the stable elbow in 17 of 21 cases. Four cases required additional MCL repair after restoration of the LCL complex. The overall mean MEPS was 91 (range, 70 to 100): excellent in 12 cases, good in 7 cases, and fair in 2 cases. All 17 cases with LCL complex repair only and 2 of 4 cases with additional MCL repair had excellent or good results by MEPS.
CONCLUSIONS
USED requires surgical treatment to achieve a congruent and stable joint. If the repair of lateral stabilizer such as LCL complex acquires enough joint stability to maintain a full range of motion, it may not be necessary to repair the medial stabilizer in all cases of USED.

Keyword

Elbow joint; Lateral collateral ligament; Dislocation; Ligament repair

MeSH Terms

Adult
Aged
Collateral Ligaments/*surgery
Dislocations/complications/physiopathology/*surgery
Elbow Joint/*injuries/physiopathology/*surgery
Female
Humans
Joint Instability/complications/physiopathology/*surgery
Male
Middle Aged
Orthopedic Procedures/methods
Range of Motion, Articular
Retrospective Studies
Young Adult

Figure

• 

  Fig. 1 Case 3: a 38-year-old man treated by repair of lateral collateral ligament (LCL) complex alone. (A) Initial radiograph showing dislocation on left elbow. (B) After closed reduction, the elbow was not congruent on lateral view. (C) Magnetic resonance imaging scan showing injuries of LCL complex and sprain of medial collateral ligament. (D, E) Radiographs at postoperative 3 months showing stable elbow. (F, G) Photographs at postoperative 3 months.

• 

  Fig. 2 Case 10: a 30-year-old injured by a fall from height. (A, B) Initial radiographs showing dislocation of the left elbow and associated fracture of the left wrist. (C) A lateral radiograph after closed reduction demonstrated a persistent subluxation of radio-capitellar and widening of ulno-humeral joint. (D) Magnetic resonance imaging scan showing injuries of lateral collateral ligament (LCL) complex and medial collateral ligament. (E) Intraoperative photograph showing complete detachment of LCL and common extensor origin from the lateral epicondyle. (F) At 18 months after repair of LCL only, the radiograph revealed small calcification around the lateral epicondyle. (G, H) Photographs at 18 months follow-up.

Reference

1. Sheps DM, Hildebrand KA, Boorman RS. Simple dislocations of the elbow: evaluation and treatment. Hand Clin. 2004; 20(4):389–404.

2. Josefsson PO, Gentz CF, Johnell O, Wendeberg B. Surgical versus nonsurgical treatment of ligamentous injuries following dislocations of the elbow joint. Clin Orthop Relat Res. 1987; (214):165–169.

3. Josefsson PO, Johnell O, Gentz CF. Long-term sequelae of simple dislocation of the elbow. J Bone Joint Surg Am. 1984; 66(6):927–930.

4. O'Driscoll SW, Jupiter JB, King GJ, Hotchkiss RN, Morrey BF. The unstable elbow. Instr Course Lect. 2001; 50:89–102.

5. Hobgood ER, Khan SO, Field LD. Acute dislocations of the adult elbow. Hand Clin. 2008; 24(1):1–7.

6. Josefsson PO, Johnell O, Wendeberg B. Ligamentous injuries in dislocations of the elbow joint. Clin Orthop Relat Res. 1987; (221):221–225.

7. Micic I, Kim SY, Park IH, Kim PT, Jeon IH. Surgical management of unstable elbow dislocation without intra-articular fracture. Int Orthop. 2009; 33(4):1141–1147.

8. McKee MD, Schemitsch EH, Sala MJ, O'Driscoll SW. The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg. 2003; 12(4):391–396.

9. Morrey BF, An KN. Functional evaluation of the elbow. In : Morrey BF, Sanchez-Sotelo J, editors. The elbow and its disorders. 4th ed. Philadelpia: Saunders;2009. p. 80–91.

10. Josefsson PO, Nilsson BE. Incidence of elbow dislocation. Acta Orthop Scand. 1986; 57(6):537–538.

11. Borris LC, Lassen MR, Christensen CS. Elbow dislocation in children and adults: a long-term follow-up of conservatively treated patients. Acta Orthop Scand. 1987; 58(6):649–651.

12. Mehta JA, Bain GI. Elbow dislocations in adults and children. Clin Sports Med. 2004; 23(4):609–627.

13. Mehlhoff TL, Noble PC, Bennett JB, Tullos HS. Simple dislocation of the elbow in the adult: results after closed treatment. J Bone Joint Surg Am. 1988; 70(2):244–249.

14. Protzman RR. Dislocation of the elbow joint. J Bone Joint Surg Am. 1978; 60(4):539–541.

15. Josefsson PO, Gentz CF, Johnell O, Wendeberg B. Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint: a prospective randomized study. J Bone Joint Surg Am. 1987; 69(4):605–608.

16. Duckworth AD, Ring D, Kulijdian A, McKee MD. Unstable elbow dislocations. J Shoulder Elbow Surg. 2008; 17(2):281–286.

17. O'Driscoll SW, Morrey BF, Korinek S, An KN. Elbow subluxation and dislocation: a spectrum of instability. Clin Orthop Relat Res. 1992; (280):186–197.

18. Martin BD, Johansen JA, Edwards SG. Complications related to simple dislocations of the elbow. Hand Clin. 2008; 24(1):9–25.