Lateral ulnar collateral ligament (LUCL) Reconstruction using an Autologous Triceps Tendon Graft for Subclinical Posterolateral Rotatory Instability in Recalcitrant Lateral Epicondylitis.

Abstract

To evaluate mid-term outcome of LUCL repair with triceps autograft in patients with PLRI under recalcitrant lateral epicondylitis. In total 25 elbows (23 patients) with recalcitrant epicondylitis longer than 12 months were included into this retrospective study. All patients underwent arthroscopic instability examination. In 18 elbows (16 patients, mean age 47.4 years, range 25-60) PLRI was verified, and a LUCL repair using an autologous triceps tendon graft was performed. Clinical outcome was evaluated before and at least three years after surgery using the American Shoulder and Elbow Surgeons Score (ASES), Liverpool Elbow Score (LES), Mayo Elbow Performance Index (MEPI), Patient-Rated Elbow Evaluation score (PREE), Subjective Elbow Value (SEV), quick Disabilities of the Arm, Shoulder and Hand score (qDASH), and the visual analog scale (VAS) for pain. Postoperative satisfaction with the procedure and complications were recorded. Seventeen patients were available at a mean follow-up of 66.4 months (range 48-81). Patient satisfaction postoperatively was reported in 15 elbows as excellent (90-100%) and 2 as moderate with 93.1% overall. All scores of the three female and 12 male patients significantly increased from pre- to the postoperative follow-up (ASES: 28.3±10.7 to 54.6±12.1, p<0.001; MEPI: 49.2±8.3 to 90.5±15.4, p<0.001; PREE: 66.1±14.9 to 11.3±23.5, p<0.001; qDASH: 63.2±21.1 to 11.5±22.6, p<0.001; VAS: 8.75±1.0 to 1.5±2.0, p<0.001) All patients suffered from high extension pain preoperatively, which was reported to be relived after surgery. No reinstability nor major complication occurred. The repair and augmentation of the LUCL with a triceps tendon autograft reached significant improvements; hence, it seems to be a good treatment option for posterolateral elbow rotatory instability with promising mid-term results under a low rate of reinstability.