Lateral Ulnar Collateral Ligament Reconstruction with Tibialis Anterior Allograft and Internal Brace after Septic Elbow Defects.

Chronic lateral ulnar collateral ligament (LUCL) insufficiency of the elbow can develop after trauma or infection, resulting in instability and loss of motion. Although internal bracing has demonstrated promising biomechanical strength, clinical evidence combining it with allograft reconstruction remains scarce. We describe a reproducible technique for LUCL reconstruction using a tibialis anterior allograft augmented with an internal brace in patients with post-infectious lateral elbow defects. Both patients underwent staged management with infection control, cement spacer placement, and definitive ligament reconstruction using FiberTape-SwiveLock fixation. At 6 months postoperatively, both elbows achieved stability and near-normal forearm rotation. Case 1 regained almost full motion with a Mayo Elbow Performance Score (MEPS) of 95, while case 2 showed functional improvement despite mild stiffness (MEPS 85). This technique demonstrated robust fixation and clinically meaningful recovery despite compromised tissue conditions, suggesting it may be a viable option for complex post-infectious elbows.