Surgical Technique for Arthroscopic Lateral Collateral Ligament Repair.

INTRODUCTION

Arthroscopic repair of the lateral collateral ligament (LCL) complex in patients who have posterolateral rotatory instability after an unstable elbow dislocation, with or without an intra-articular fracture, is an alternative treatment for restoring stability of the elbow and obtaining successful clinical and radiographic results.

STEP 1 COMPUTED TOMOGRAPHY CT MAGNETIC RESONANCE IMAGING MRI AND PREOPERATIVE PLANNING: Obtain radiographs and CT and MRI scans to make an accurate analysis of the fracture patterns and develop an understanding of soft-tissue comorbidities.

STEP 2 POSITION THE PATIENT AND PLACE THE PORTALS: Place the patient in the lateral decubitus position and create proximal anteromedial, proximal anterolateral, anterolateral, and radial head portals as working portals and a posterior soft-spot portal as a viewing portal for the repair of the LCL complex.

STEP 3 DIAGNOSTIC ARTHROSCOPY: Identify concomitant radial head and coronoid fractures, and confirm the LCL-complex tear intraoperatively.

STEP 4 MANAGEMENT OF CONCOMITANT INJURIES: Treat intra-articular fractures arthroscopically before the LCL-complex repair.

STEP 5 ARTHROSCOPIC LCL-COMPLEX REPAIR VIDEO 1: After soft-tissue debridement using the soft-spot portal as a viewing portal and the proximal anterolateral portal as a working portal, decorticate the footprint of the humeral attachment of the LCL complex with use of a shaver or burr and then make a modified Mason-Allen stitch using a needle, fixing the suture with a knotless anchor, to achieve a stable elbow joint.

STEP 6 POSTOPERATIVE MANAGEMENT: After postoperative immobilization of the elbow for 2 to 3 days, instruct the patient to perform passive exercises, returning to a full range of motion at 4 to 6 weeks after surgery, and typically returning to full activity at 3 months after the operation.

RESULTS

To date, arthroscopic LCL-complex repair has produced excellent results, with all 13 patients in our original study reporting complete resolution of the elbow instability and demonstrating a negative result on the lateral pivot-shift test15.