Lateral collateral ligament injuries of the elbow – chronic posterolateral rotatory instability (PLRI) (original) (raw)
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PLRI: posterolateral rotatory instability of the elbow
Clinics in Sports Medicine, 2004
Posterolateral rotatory instability (PLRI) of the elbow is the term coined to describe the condition in which the proximal ulna and radial head externally rotate about the distal humerus when the forearm is positioned in supination and slight flexion. This pattern of ligamentous instability, which has been recently described, results from insufficiency of both the static ligamentous stabilizers and the dynamic stabilizers about the posterolateral elbow. The principal static stabilizing component is the lateral ulnar collateral ligament (LUCL), which originates at the lateral epicondyle and extends to the crest of the proximal ulna. LUCL insufficiency permits the proximal ulna and radial head to rotate externally and posterior to the distal humerus. PLRI has been portrayed in recent studies as existing on a continuum from subtle laxity to recurrent elbow dislocation. For patients whose instability symptoms persist despite appropriate conservative measures, repair or reconstruction of the lateral ligament complex may provide significant relief and functional improvement. In this article, the authors reiterate the history and salient clinical features that accompany posterolateral rotatory instability of the elbow and the definitive surgical technique for treatment of this condition [1]. History The term posterolateral instability of the elbow (PLRI) was introduced by O'Driscoll et al in a 1991 report [2] that describes 5 patients with persistent recurrent instability of the elbow. Preceding this report by O'Driscoll, however, there were several reports in the literature describing similar elbow pathology. In
Arthroscopy Techniques, 2016
Posterolateral rotatory instability (PLRI) of the elbow is a chronic condition that results from lateral collateral ligament complex injury and presents with pain, clicking, and subluxation within the flexion and extension arcs of elbow motion. The primary cause involves a lesion of the lateral collateral ligament complex and its avulsion from the lateral epicondyle. In most cases, it is the result of trauma such as a fall on an outstretched hand or any other mechanism that imparts axial compression, valgus force, and supination. Several surgical techniques have been described for the treatment of PLRI, but there is no consensus regarding the ideal surgical treatment. The advantages of an arthroscopic approach for the treatment of PLRI are first diagnostic. Arthroscopy allows for visualization and diagnosis of every compartment of the elbow. The main steps of the surgical procedure consist of reinsertion of the lateral collateral ligament, anterior capsular plication, and coronoid tunneling. By use of this technique, it is possible to perform an anatomic repair and provide stability of the elbow.
Surgical Treatment of Posterolateral Rotatory Instability of the Elbow
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014
The purpose of this systematic review was to critically examine the outcomes of lateral ulnar collateral ligament reconstruction for posterolateral rotatory instability (PLRI) of the elbow. Methods: A systematic review of the literature was performed. Two reviewers assessed and confirmed the methodologic and patient data from the included studies. Frequency-weighted means were calculated for outcomes that were present in multiple studies. Results: Eight studies fulfilled our criteria, and they included 130 patients. The mean age was 38.1 years, and the mean follow-up period was 44.5 months. Traumatic dislocation was the most common cause of PLRI. Of the studies that reported the Mayo Elbow Performance Score, 91% of patients had good or excellent results, with a frequency-weighted mean of 91. Improvement in elbow range of motion was noted (133 to 138 of flexion [P < .0001] and 6.6 to 3.9 of extension [P ¼ .005]). A complication rate of 11% was noted, with recurrent instability noted to occur in 8% of patients. Conclusions: PLRI of the elbow remains to be fully understood. Treatment strategies vary and should be performed based on surgeon experience and evidence available. Most patients will have good or excellent results after surgery; however, up to 11% of patients may have complications. Level of Evidence: Level IV, systematic review of Level II through IV studies.
Curēus, 2024
Background Posterolateral rotatory instability of the elbow arises from damage to the lateral ulnar collateral ligament (LUCL). While various methods exist for reconstructing or repairing the LUCL's attachment to the humerus, the most effective approach remains debatable. This study aims to assess the outcomes of directly repairing the LUCL when the injury occurs at the humeral attachment. Methodology This retrospective study, conducted at the Royal Berkshire Foundation Trust NHS hospital in Reading, UK, assessed outcomes through a review of 15 patients who underwent direct repair of the lateral ulnar collateral ligament between 2017 and 2022, evaluating a range of motion, the Mayo Elbow Performance Score, and the Nestor grading system. Results This study included nine males and six females, with an average age of 38.8 years. Most LUCL injuries arose from elbow dislocation (46.7%). The average follow-up period for patients was 26 months. At the final assessment, the mean Mayo Elbow Performance Score reached 99. According to the Nestor grading system, 12 patients achieved excellent results, and three had good outcomes. On average, there was an 11.3° loss of final extension and 5° of final flexion, yet achieving a comparable pronation-supination arch to the contralateral side. Conclusion Direct repair of the LUCL for elbow posterolateral rotary instability yielded excellent outcomes, obviating ligament reconstruction. Recognized as minimally invasive, it accelerates recovery, minimizes trauma, and offers a cost-effective procedure for managing instability.
The American Journal of Sports Medicine, 2020
Background: Posterolateral rotatory instability (PLRI) of the elbow can lead to pain, recurrent dislocations, and, in the worst-case scenario, disability. Purpose: To report the indications, outcomes, and complication rates of lateral ulnar collateral ligament (LUCL) reconstruction for chronic PLRI of the elbow. Study Design: Systematic review. Methods: This systematic review was registered with PROSPERO and performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The review entailed 17 studies that included 168 patients with isolated LUCL reconstruction for chronic PLRI. Patients with concurrent medial collateral ligament reconstruction were excluded. The primary outcome measures were patient characteristics, indication for surgery, surgical technique, functional outcomes, and complications. Results: Chronic PLRI commonly occurred after a previous traumatic injury (n = 168). Of these, there were 119 simple instabilities (n...
Role of the lateral collateral ligament in posteromedial rotatory instability of the elbow
Journal of Shoulder and Elbow Surgery, 2017
Background: Posteromedial rotatory instability (PMRI) of the elbow consists of an anteromedial coronoid fracture with lateral collateral ligament (LCL) and posterior bundle of the medial collateral ligament (PMCL) tears. We hypothesized that the LCL tear is required for elbow subluxation/joint incongruity and that an elbow affected by an anteromedial subtype 2 coronoid fracture and a PMCL tear exhibits contact pressures different from both an intact elbow and an elbow affected by PMRI. Materials and methods: Six cadaveric elbows were tested under gravity varus stress using a custom-made machine designed to simulate muscle loads and to passively flex the elbow from 0°to 90°and measure joint contact pressures. After testing of the intact specimen (INTACT-elbow), an anteromedial subtype 2 coronoid fracture with a PMCL tear (COR+PMCL-elbow) and a PMRI injury (PMRI-elbow), after adding an LCL tear, were tested. The highest values of mean contact pressure were used for the comparison among the 3 groups. Results: Neither subluxation nor joint incongruity was observed in the COR+PMCL-elbow. The addition of an LCL detachment consistently caused subluxation and joint incongruity. Mean contact pressures were higher in the COR+PMCL-elbow compared with the INTACT-elbow (P < .03) but lower than in the PMRI-elbow (P < .001). Conclusions: The LCL lesion in PMRI is necessary for elbow subluxation and causes marked elevations in contact pressures. Even without subluxation, the COR+PMCL-elbow showed higher contact pressures compared with the INTACT-elbow. Treatment of PMRI should be directed toward prevention of joint incongruity, whether by surgical or nonsurgical means, to prevent high articular contact pressures.
Clinical Presentation of Posterolateral Rotatory Instability of the Elbow in Children
The Journal of Bone and Joint Surgery-American Volume, 2013
Background: Posterolateral rotatory instability is a type of ulnohumeral instability seen following elbow trauma. It is caused by a deficiency in the lateral collateral ligament complex that allows the radius and ulna to subluxate as a single unit with respect to the distal part of the humerus. There are few studies on this type of instability in children. Our purpose was to evaluate cases of posterolateral rotatory instability in children to better understand its presentation and manifestation as compared with those in adults. Methods: This was a retrospective chart review of patients from three academic centers. Eligible for inclusion were patients with a diagnosis of posterolateral rotatory instability who were treated with lateral ulnar collateral ligament reconstruction when they were less than nineteen years of age.
Injury, 2020
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