Ligamentous Reconstruction with Semitendinosus Tendon Autograft for Posterolateral Rotatory Instability of Elbow—a Case Report with an Update of Literature Review

Abstract

The elbow joint is a comparatively very stable joint owing to the adjacent osseo-ligamentous complex structural integrity around the joint. Posterolateral rotatory instability (PLRI) primarily refers to an injury of the lateral ulnar collateral ligament (LUCL) and the lateral ligamentous complex collectively referred to as the lateral collateral ligament (LCL). PLRI is often a neglected or missed injury, hence remains a relatively rare clinical entity, and reconstruction of the injured ligament is the mainstay of management. A 25-year-old male presented to the orthopedic outpatient department with complaints of post-traumatic instability with dull aching pain over the left elbow for the last 1 year. Varus stress test along with a positive pivot shift test established the clinical diagnosis of posterolateral elbow instability. The LUCL reconstruction was considered using the ipsilateral semitendinosus autograft tendon. At the final follow-up of 1.5 years, the VAS score improved from 8/10 to 1/10 during moderate activities, the Mayo elbow performance score improved from 40/100 to 85/100, and the DASH score was 10.7/100 from preoperative 52.5/100 without any clinical evidence of residual elbow instabilities. The hamstring tendon autograft is a reliable and an easily available option for reconstruction of LUCL owing to its superior inherent graft tensile strength, which helps in improving the elbow instability with minimum effect on donor site morbidities.