Ligamentous reconstruction around the elbow using triceps tendon

Abstract

Posttraumatic instability of the elbow joint can be osseous or ligamentous. Ligamentous instability can be in valgus or in posterolateral rotatory direction. Rupture of both the lateral and medial collateral ligament of the elbow can be seen as an isolated injury, or it can be part of a more complex injury such as a dislocation. Persistent insufficiency of the lateral collateral ligament of the elbow results in posterolateral rotatory instability. Insufficiency of the medial collateral ligament, the anterior part in particular, results in valgus instability. Persistent symptoms after nonoperative treatment are an indication for reconstruction. In the past, ligamentous reconstruction at both the lateral and medial side was performed using palmaris tendon graft through bony drill holes.In this article I describe a new technique using ipsilateral triceps tendon, fixed in drill holes using bioabsorbable interference screws. This technique allows simplified graft tensioning and improved graft fixation, and avoids the risk of fracturing of the bony tunnels. An accelerated rehabilitation protocol can be applied. The final result depends on proper isometric reconstruction, associated lesions or degeneration of the elbow joint and adequate after-treatment. Taking these factors into account, the technique described shows promising short-term results.