LIGAMENT RECONSTRUCTION WITH A SINGLE STRAND TRIZEPS TENDON GRAFT IN POSTEROLATERAL ROTATIONAL INSTABILITY OF THE ELBOW

Abstract

Problem: Surgical technique and short term results of ligament reconstruction with trizeps tendon graft in posterolateral rotational instability of the elbow

Methods: From 2003 to 2006 posterolateral ligament reconstruction with a single strand trizeps tendon graft was performed in 38 patients with posterolateral instability of the elbow, mainly associated with refractory lateral epicondylitis. The reconstructions were performed with the original O Driscoll technique (6), interference screw fixation (30) and transfixation screw (2). There were no neurological complications, one superficial wound infection resolved by revision and 3 arthroscopic revisions for intraarticular scaring.

The first 21 operated patients with a minimum follow up of twelve months were reviewed with a subjective 100 point rating score.

Results: From 21 patients 4 could not be reached by letter or telephone, 2 patients were excluded for pre-operative stiffness and previous operations other than extensor release. 15 patients could be evaluated. Average follow up was 15,1, min 12, max 24 months. Patients satisfaction with the operation was rated very good by 6 patients (40%), good by 5 (33,3%) unchanged by 4 (26,7 %), none worsened. Mean postoperative score was 83/100 points. Mean score for pain was 22,2/30, for ADL 7,3/8, sleep 1,9/2, range of arm motion 9,2/10, extension 9,2/10, flexion 4,6/5, supination 4,7/5, pronation 4,2/5 and strength 20,1/25 points.

Conclusion: Single strand posterolateral ligament reconstruction with a trizeps tendon graft in posterolateral instability of the elbow shows reliable short term results. More secure fixation is achieved with bone tunnel fixation and tenodesis or transfixation