Medial and Lateral Ligament Bracing in Severe Elbow Instability After Acute Elbow Dislocation.

PURPOSE: Augmentation of the medial and lateral collateral ligaments using additional ligament bracing has been shown to improve primary stability in biomechanical studies considerably. However, the general indication for ligament bracing remains a topic of discussion. This study aimed to present clinical outcomes in the treatment of severe medial and lateral elbow instability using ligament bracing.

METHODS: This retrospective study included patients treated for severe medial and lateral elbow instability with ligament bracing. Inclusion criteria were rupture of the medial and lateral ligaments. Severe instability was defined as recurrent dislocation during motion testing after reduction or as decentration on computed tomography or magnetic resonance imaging. Surgical treatment involved repair of the medial and lateral capsule ligament complex with additional ligament bracing. Clinical outcomes were evaluated based on range of motion, Disabilities of the Arm, Shoulder, and Hand score, and subjective satisfaction. Revisions were analyzed.

RESULTS: Thirty-three patients with a mean age of 49 years and a mean follow-up of 30 months were included. The Disabilities of the Arm, Shoulder, and Hand score was 15 (range 0-71), and patient satisfaction was 80% (range 20% to 100%). The mean range of motion in extension/flexion was 117° (range 45° to 160°), and pronation/supination was 172° (range 150° to 180°). Overall, 5 revisions (15.2%) were performed, including 1 for recurrent instability 8 days after surgery.

CONCLUSIONS: Ligament bracing in the treatment of severe medial and lateral elbow instabilities could restore elbow stability and show good clinical results with a low complication rate. The main reason for the revisions is elbow stiffness. It remains unclear to what extent these are a consequence of the rigid implant or significant trauma.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.