Non-anatomical reconstruction of lateral ulnar collateral ligament of the elbow after tumor resection.

Masuo Hanada,Y Iwamoto,H Kadota,T Matsunobu,E Shimada

doi:10.1007/s11751-015-0235-1

Masuo Hanada, Y Iwamoto + Show 3 more

Open Access

https://doi.org/10.1007/s11751-015-0235-1

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Abstract

We present the case of an 80-year-old man with a tumor recurrence on his right arm 6 years after initial treatment. The lateral aspect of the elbow joint, involving overlaying skin, muscles, tendons, joint capsule, lateral collateral ligament complex, the lateral 1/3 of the capitellum, and lateral epicondyle of humerus were excised in the tumor resection. Intraoperative assessment revealed multidirectional instability of the elbow, and joint stabilization was needed. Because the lateral epicondyle was resected, graft placement in an anatomical position was impossible to carry out. Therefore, non-anatomical reconstruction of lateral ulnar collateral ligament with palmaris longus tendon graft was performed. The skin was reconstructed using an antegrade pedicled radial forearm flap. For wrist extension reconstruction, the pronator quadratus tendon was transferred to the extensor carpi radialis brevis tendon. One year after the operation, elbow range of motion was 5–130°. The patient remains symptom free. The Mayo elbow performance score is good. The Musculoskeletal Tumor Society rating score is excellent. To our knowledge, this is the first report of an elbow lateral ulnar collateral ligament reconstruction after tumor resection.

Highlights

Amputation used to be the primary treatment for patients with soft tissue tumors of the extremities [1]
The lateral aspect of the elbow joint, involving overlaying skin, muscles, tendons, joint capsule, lateral collateral ligament complex, the lateral 1/3 of the capitellum, and lateral epicondyle of humerus were excised in the tumor resection
The pronator quadratus tendon was transferred to the extensor carpi radialis brevis tendon

Summary

Introduction

Amputation used to be the primary treatment for patients with soft tissue tumors of the extremities [1]. There are no reports of elbow lateral ulnar collateral ligament (LUCL) reconstruction after tumor resection. Wide resection of the recurrent tumor and reconstruction was planned. As a result of tumor wide resection, there was no tissue above the lateral part of the elbow joint, and the elbow suffered gross varus instability (Fig. 1a). To prevent impaction of the grafted tendon against the radial head during elbow extension, the ulnar bone tunnel was placed near the insertion of annular ligament (Fig. 1b, c). Full range of motion of the elbow joint and tightness of the planned tendon graft were confirmed with a suture placed through the bone tunnel.

Discussion

Compliance with ethical standards