Summary

The use of arthroscopic imbrication on the lateral collateral ligament (LCL), in cases of grade I or II posterolateral rotatory instability (PLRI) produces early favorable outcomes with minor complications.

Abstract

Background

The most common pattern of elbow instability is the posterolateral rotatory elbow instability (PLRI). So far, the gold standard in treatment has been LCL reconstruction by using one of several open techniques. This cohort study presents the results of a less invasive approach, the arthroscopic LCL imbrication technique, in order to reduce grade I or II PLRI.

Methods

Twenty- one patients with stage I or II PLRI who had failed conservative therapy, were included. Diagnosis of PLRI involved trauma on nine patients, chronic lateral elbow pain on five and previous open procedure for tennis elbow on seven patients. The LCL imbrication technique was performed after clinical diagnosis (proved also with arthroscopic abnormal findings) was confirmed. Range of motion (ROM) and the Mayo Elbow Performance Score (MEPS) were evaluated pre and post-operatively. The Shapiro-Wilk normality test was used to evaluate the normal distribution of the sample. Differences between pre- and post-operative MEPS score were analyzed with a Wilcoxon signed rank test. Minimum follow-up was 12 months (range 12-36 months; periods of postoperative follow-up outcome measurement: three months, six months, 12 months and yearly thereafter).

Results

MEPS improved from a median of 45 (range 30–80) points pre-operatively to 100 (range 85–100) at three months and 100 (range 95-100) at 12 months follow-up (p < 0.0001). Median post-operative flexion was 145°, and extension was 0°. At 12 months, a post-operative extension deficit of 10o was observed in two patients; 19/21 (90.5%) of patients reached full ROM. Knot irritation was witnessed in two patients (9.5%).

Conclusions

Arthroscopic LCL imbrication delivers favorable clinical results in individuals with grade I or II PLRI from the third postoperative month . This technique may result in a slight restriction in range of motion and knot discomfort in few patients.