Anconeus sparing minimally invasive approach for lateral ulnar collateral ligament reconstruction using a triceps tendon autograft is an effective and safe treatment for chronic posterolateral instability of the elbow.

BACKGROUND: Surgical treatment helps to restore stability of the elbow in patients with posterolateral rotatory instability (PLRI). The anconeus muscle is one of the most important active stabilizers against PLRI. A minimally invasive anconeus sparing approach for lateral ulnar collateral ligament (LUCL) reconstruction using a triceps tendon autograft has been previously described. The purpose of this study was to evaluate the outcome of this intervention and identify risk factors that influenced the clinical and patient reported outcomes.

METHODS: Sixty-one patients with chronic PLRI and no previous elbow surgery that underwent surgical reconstruction of the LUCL using a triceps tendon autograft in a minimally invasive anconeus sparing approach during 2012 and 2018 were evaluated. Outcome measures included a clinical examination and the Oxford Elbow Score (OES) and the Mayo Elbow Performance Score (MEPS) questionnaires. Subjective patient outcomes were evaluated with the Visual analogue scale (VAS) for pain and the Subjective Elbow Value (SEV). Integrity of the common extensor tendons and centering of the radial head were assessed preoperatively on standardized MRIs.

RESULTS: Fifty-two patients were available at final follow-up. The mean age of patients was 51±12 years with a mean follow-up of 53±14 months (range 20-76). Clinical examination after surgery (n=41) showed no clinical signs of instability in 98% of the patients (P <.001) and a non-significant improvement in range of motion. OES, MEPS and VAS averaged 40±10 out of 48 points, 92±12 out of 100, and 1±2, respectively, all corresponding with good or excellent outcomes. The SEV was 88% indicating very high satisfaction with the surgery. Only one patient had revision surgery due to pain and there were no reported postoperative complications in this cohort. A radial head subluxation in the MRI correlated significantly with worse post operative outcomes.

CONCLUSIONS: The anconeus sparing minimally invasive technique for posterolateral stabilization of the elbow using a triceps tendon autograft is an effective and safe treatment for chronic posterolateral instability of the elbow with substantial improvements in elbow function and pain relief with a very low rate of persistent clinical instability.