Patients › Elbow

Rekonstruksyon ng Ligamento sa Siko (Stabilisasyon)

Updated Sep 2026

Bakit iminungkahi ang operasyong ito¶

Si Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay itinutugma ang gamutan sa iyong partikular na pinsala. Ang mga pasyente ay karaniwang nirerefer sa aming klinika ng kanilang GP; kung iminungkahi ng isang physiotherapist na magpatingin sa amin, kakailanganin mo pa rin ng referral mula sa iyong GP upang maging eligible para sa Medicare rebate. Sa iyong appointment, kumukuha kami ng history, sinusuri ang iyong siko, at nag-aayos ng mga scan kung kinakailangan upang malaman kung ano ang problema.

Ang elbow ligament reconstruction ay isang operasyon na muling bumubuo sa isang gasgas o punit na ligament gamit ang isang piraso ng donor tendon, upang panatilihing matatag ang joint. Karaniwan namin itong iminumungkahi kapag nararamdaman mo pa ring bumibigay ang iyong siko, o hindi nananatili sa puwesto, matapos ang ibang gamutan na hindi nagbigay ng sapat na pagbuti. Inaalok din ito kapag ang siko ay mapapanatili lamang sa joint sa pamamagitan ng paghawak dito nang halos diretso, o kapag ang isang fracture sa paligid ng joint ay nag-iwan dito na unstable. Ang layunin ay isang matatag na siko na maaari mong igalaw, gamitin, at asahan nang walang sakit. Ang allograft reconstruction ay nagbabalik ng stability ng siko sa humigit-kumulang 85% ng mga siko na may posterolateral rotatory instability. Pag-uusapan namin ito nang detalyado kasama ka at magpapasya nang magkasama kung ito ay angkop para sa iyong siko at sa iyong mga layunin.

Bago ang operasyon¶

Sa mga linggo bago ang operasyon, tinatapos namin ang pagpaplano gamit ang mga scan gaya ng X-ray, MRI (isang scan na nagpapakita ng mga soft tissue tulad ng mga ligament), o ultrasound. Sa araw ng operasyon, itigil ang pagkain at pag-inom pitong oras bago ito. Humihingi kami ng pitong oras upang maaaring mapabilis ang iyong operasyon kung maagang matapos ang listahan sa theatre; kumpirmasyon ng iyong surgeon ang eksaktong oras ng iyong pag-aayuno. Maaaring kailanganin mong itigil muna ang ilang gamot bago ang operasyon, at bibigyan ka namin ng malinaw na mga tagubilin kung alin sa mga ito at kung gaano katagal. Magdala ng nakasulat na listahan ng lahat ng iyong iniinom o ginagamit, kabilang ang mga tablet, patak, at cream. Mag-ayos ng taong maghahatid sa iyo pauwi pagkatapos. Magsuot ng maluwag at komportableng damit na may mga manggas na madaling maiangat lampas sa iyong siko. Kung mayroon kang iba pang kondisyong medikal, maaaring kailanganin mo rin ng mga blood test o pagsusuri kasama ang anaesthetist (ang doktor na nagbibigay ng anaesthetic).

Sa araw ng operasyon¶

Darating ka sa surgical admissions unit ng ospital, kung saan ka ire-rehistro at ihahanda para sa theatre. Makikilala mo doon ang anaesthetist. Ang operasyong ito ay ginagawa sa ilalim ng general anaesthetic. Minsan ay nagdaragdag ng regional nerve block para sa pagpapaginhawa ng sakit pagkatapos ng operasyon; tatalakayin ito ng anaesthetist sa iyo sa araw na iyon. Pagkatapos ay dadalhin ka sa operating theatre, kung saan isasagawa ang operasyon. Kapag natapos na ito, magigising ka sa recovery area, kung saan babantayan ka ng mga nurse habang nawawala ang bisa ng anaesthetic. Kapag stable ka na, pupunta ka sa ward o uuwi na, depende sa procedure at sa iyong paggaling.

Simple lang ang layunin ng araw na ito: ibalik ang sapat na stability sa iyong siko upang maaari itong simulang igalaw agad pagkatapos ng surgery. Ang pagpapanatiling hindi gumagalaw ng siko sa loob ng mahabang panahon pagkatapos ay may tendensiyang magdulot ng paninigas nito, kaya ang maagang paggalaw ay bahagi ng plano.

Ano ang kinapapalooban ng operasyon¶

Ang mga eksaktong hakbang ay nakadepende sa kung aling mga istruktura sa paligid ng iyong siko ang napinsala, at pinaplano namin ito mula sa iyong mga scan bago ang araw ng operasyon. Kung ang bali (fracture) ay bahagi ng problema, aayusin muna ng iyong surgeon ang mga nabaling piraso ng buto gamit ang mga screw o isang maliit na plate. Kung ang isang nabaling piraso ng buto sa itaas ng forearm ay hindi na maaaring kumpunihin, maaari itong palitan ng isang metal implant. Kapag secure na ang buto, ang mga napunit na ligament ay kumpunihin o muling bubuuin.

Ang muling pagbuo ng ligament ay nangangahulugang paggawa ng bago mula sa isang piraso ng tendon. Maaari itong manggaling sa donor tissue, o mula sa iyong sariling katawan. May mga maliliit na anchor na humahawak sa bagong ligament sa buto sa mga tamang posisyon, at sinusuri ng iyong surgeon na ang siko ay nananatili sa joint sa buong range of movement nito bago tapusin. Minsan, isang matibay na suture tape ang idinaragdag kasabay ng pagkumpuni upang magsilbing internal brace, na sumusuporta sa ligament habang ito ay gumagaling. Kung ang siko ay hindi pa rin nananatiling matatag, maaaring lagyan ng pansamantalang hinge upang mapanatili ito sa posisyon habang naghihilom ang lahat.

Ang operasyon ay madalas na maaaring gawin sa pamamagitan ng maliliit na hiwa sa halip na isang mahabang bukasan. Para sa ilang ligament rebuilds, sapat na ang hiwa na may laki na mga 2 hanggang 3 cm. Ang pagtatrabaho sa pamamagitan ng maliliit na hiwa ay nagpoprotekta sa mga malulusog na tendon at muscle sa paligid ng joint, at umiiwas sa pag-abala sa mismong joint lining.

Kapag tapos na ang pagkumpuni, ang mga hiwa ay sasara gamit ang mga tahi at tatakpan ng dressing. Ang layunin ng buong operasyon ay isang matatag na siko na maaaring magsimulang gumalaw agad pagkatapos, dahil ang pagpapanatili nito na hindi gumagalaw nang masyadong matagal ay may tendensiyang mag-iwan dito ng paninigas (stiffness).

Pagkatapos ng operasyon¶

Magigising ka sa recovery area, kung saan babantayan ka nang maigi ng mga nurse habang nawawala ang bisa ng anaesthetic. Ang iyong braso ay ilalagay sa isang sling o susuportahan ng mga unan, na may dressing sa ibabaw ng mga sugat. Bibigyan ka namin ng pain relief at titiyakin na ito ay gumagana bago ka gumalaw. Dapat may kasama ka sa unang 24 oras pagkatapos mong umuwi. Sasabihin sa iyo ng iyong team kung uuwi ka sa araw ring iyon o mananatili ng isang gabi sa ospital. Hahayaan naming nakalagay ang dressing sa loob ng humigit-kumulang 10 araw; pakiusap na huwag itong tanggalin bago ang panahong iyon maliban kung sinabi namin sa iyo. Papalitan o tatanggalin namin ito kapag nakita ka na namin. Karamihan ng mga tao ay maaaring maglakad-lakad at gumawa ng mga magagaan na gawain agad, ngunit panatilihing nakapahinga ang iyong siko sa sling kapag ikaw ay nakatayo at kumikilos.

Paggaling¶

Sa unang ilang araw, ang iyong siko ay magiging masakit at mamamaga. Unti-unti itong huhupa. Ang pahinga, pagpapanatiling nakataas ng iyong braso, at ang pain relief na ibibigay namin sa iyo ay magpapabawas ng discomfort. Ang ilang pananakit kapag nagsimula mo nang igalaw ang joint ay normal at bumubuti habang lumilipas ang mga linggo.

Uuwi ka na ang iyong braso ay nasa sling. Maaari kang maglakad-lakad at gumawa ng mga magaang gawain agad, ngunit panatilihing nakapahinga ang iyong siko sa sling kapag ikaw ay gumagalaw. Ang iyong kamay at pulso ay maaaring igalaw nang maaga, at ang mga banayad na ehersisyo para sa mga ito ay karaniwang nagsisimula sa loob ng ilang araw. Ang hand therapy pagkatapos ng operasyon ay kay Ruby Doolan sa Extend Rehabilitation. Si Ruby ay isang hand therapist: gagabayan niya ang iyong mga ehersisyo at gagawa ng anumang splint na iyong kakailanganin. Ang layunin ng therapy ay matatag at maagang paggalaw, dahil ang pagpapanatiling hindi gumagalaw ng siko nang masyadong matagal ay may tendensiyang mag-iwan nito na matigas (stiff).

Habang humuhupa ang pamamaga, mas gagamitin mo na ang iyong braso: pagkain, pagsusulat, at mga magaang gawaing bahay. Kapag kuntento na ang iyong surgeon na secure ang repair, tatanggalin na ang sling at magsisimula ka nang itiklop at ituwid ang siko mismo. Ang paggalaw ay madalas na bumubuti nang mabilis sa simula, pagkatapos ay mas mabagal. Kapag kaya mo nang humawak at kumapit sa mga bagay nang walang sakit, ang mga pang-araw-araw na aktibidad ay magiging mas madali. Ang pagmamaneho ay hindi ligtas habang ang iyong braso ay nasa sling, at kakailanganin mong maging may kakayahang humawak sa manibela gamit ang dalawang kamay at rumesponde sa isang emergency stop, nang walang iniinom na matapang na pain medication. Ang aming gabay sa pagmamaneho pagkatapos ng upper-limb surgery ay nagpapaliwanag kung kailan ka maaaring bumalik.

Ang bawat isa ay gumagaling sa sarili nilang bilis. Maaaring magkaiba ang iyong timeline, at gagabayan ka ng iyong surgeon at therapist sa prosesong ito.

Ano ang maaaring maging problema¶

Karamihan sa mga pasyente ay gumagaling nang maayos, ngunit paminsan-minsan ay maaaring magkaroon ng mga problema. Binabantayan kayo nang maigi ng inyong surgeon at ng team upang maagapan ang anumang isyu.

Ang nerve na dumadaan sa loob ng inyong siko ay maaaring mairita pagkatapos ng operasyon. Maaari kayong makaramdam ng pangingilig, parang tinutusok ng karayom, o pamamanhid sa inyong ring finger at kalingkingan. Kadalasan ay nawawala ito nang kusa, ngunit ipaalam sa amin kung hindi ito humuhupa, o kung nanghihina ang mga daliri.

Ang siko ay maaaring manatiling maluwag o pakiramdam na muling bumibigay. Kung ang inyong siko ay nagsisimulang maging hindi matatag, o nalalaglag mula sa posisyon nito, makipag-ugnayan agad sa klinika.

Ang siko ay maaari ring tumigas. Maaaring mahirapan kayong ituwid o itiklop nang lubos ang braso, at ang paggalaw ay maaaring maramdamang nakabara sa halip na masakit. Banggitin ito sa inyong review, dahil ang karagdagang therapy o iba pang gamutan ay maaaring makatulong.

Ang impeksyon ay hindi karaniwan ngunit seryoso. Bantayan ang malalim at pumupulsong sakit na hindi humuhupa sa simpleng painkiller, pamumula na kumakalat mula sa sugat, o pagtagas ng likido mula rito. Kung mapansin ang mga ito, tawagan ang klinika sa mismong araw na iyon, o pumunta sa emergency department kung kayo ay nilalagnat o masama ang pakiramdam.

Ang maliliit na metal anchor o screw na ginamit upang hawakan ang repair ay maaaring magdulot ng iritasyon, o ang isang pansamantalang hinge ay maaaring lumuwag. Maaari kayong makaramdam ng bagong pag-click, pag-catch, o bukol sa ilalim ng balat. Banggitin ito sa inyong susunod na review.

Kung saan ginamit ang isang bahagi ng inyong sariling tendon upang muling buuin ang ligament, ang bahaging iyon ay maaaring manatiling maselan o kumikirot sa loob ng ilang panahon. Ipaalam sa amin kung ito ay lumalala sa halip na bumubuti.

Ang buto ay maaaring mabuo kung saan hindi ito dapat, sa paligid ng joint o sa loob nito. Maaari nitong limitahan ang paggalaw o magdulot ng pag-catch at pag-grind. Kung ang inyong siko ay huminto sa pag-unlad, banggitin ito sa inyong review.

Ang peklat mismo ay maaaring paminsan-minsang bumuka o maglabas ng likido. Kung ang sugat ay bumukas, lalong namumula, o nagsimulang magkaroon ng discharge, makipag-ugnayan sa amin sa halip na maghintay.

Ang table ng mga komplikasyon sa pahinang ito ay naglilista ng mga tipikal na rate kung nais ninyo ang mga detalye.

Kailan dapat tumawag sa amin¶

Karamihan sa mga problema ay lumalabas nang maaga, at mas gusto naming malaman ang mga ito nang mas maaga kaysa huli na. Tumawag sa amin kung ikaw ay may lagnat, kung ang sugat ay lalong namumula o nagsisimulang maglabas ng likido, o kung ang iyong sakit ay patuloy na lumalala sa halip na humupa. Pumunta sa emergency kung ikaw ay may pamamaga o sakit sa iyong binti (calf), o biglaang pagkapos ng hininga. Tumawag sa amin agad kung ang iyong ring finger at kalingkingan ay namamanhid, kung ang iyong kamay ay nanghihina, o kung hindi mo na maigalaw ang iyong braso. Kung ang iyong siko ay nalukot o pakiramdam mo ay muling bumibigay, makipag-ugnayan sa klinika sa mismong araw na iyon.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

An all-arthroscopic technique for reconstruction of the lateral ulnar collateral ligament (LUCL) is reproducible and avoids residual instability [1].
Open posterolateral ligament plication and LUCL repair using an all-suture construct allows for complete posterolateral stabilization of the elbow with a single implant and bone preservation [2].
A suture-augmented LUCL and radial collateral ligament reconstruction method provides a reproducible, anatomically based construct that restores posterolateral elbow stability [3].
The suture-augmented LUCL and radial collateral ligament reconstruction method addresses the complex spectrum of lateral-sided injuries observed in posterolateral rotatory instability (PLRI) [3].
An arthroscopic LUCL plication/reconstruction with augmented lateral collateral ligament imbrication is a minimally invasive method that allows effective management of elbow instability [4].
The arthroscopic LUCL plication/reconstruction with augmented lateral collateral ligament imbrication promotes quicker patient recovery and long-term functional restoration [4].
The use of suture button fixation for repair of the lateral ulnar collateral ligament in terrible triad injuries has not been previously described [5].
Reconstruction of the lateral ulnar collateral ligament with a tendon graft offers an alternative that restores stability through a dynamic “sling effect” rather than rigid constraint [6].

Anatomy & Pathophysiology¶

Bony Anatomy¶

The elbow is a trocho-ginglymoid joint consisting of medial and lateral articulations that provide bony stability [11].
The trochlea articulates with the ulna within the greater sigmoid notch to create the ulnohumeral, hinged, or trochoid portion of the elbow joint [11].
The ulnohumeral articulation has highly congruent anatomy through almost 180° of articular contact, except for the bare area of the greater sigmoid notch which is devoid of cartilage [11].
The coronoid has a medial and lateral facet which buttresses the trochlea anteriorly [11].
The sublime tubercle is located just distal and medial to the coronoid and provides the attachment site for the anterior bundle of the medial ulnar collateral ligament [11].
The medial epicondyle forms the attachment site for the origins of the flexor pronator mass and is larger and more posteriorly oriented than the lateral epicondyle [11].
The capitellum and radial head form the radiocapitellar joint [11].
The radius is held in close approximation to the ulna at the proximal radioulnar joint by the annular ligament [11].
The area of the ulna which articulates with the margin of the radial head at the proximal radioulnar joint is known as the lesser sigmoid notch [11].
The radial head is a concave elliptical structure covered with articular cartilage along the radiocapitellar joint and approximately 270° of the articular margin [11].
The radial head articulates with both the capitellum and the lesser sigmoid notch [11].
The lateral epicondyle is the origin of the lateral extensor musculature [11].
The origin of the lateral ulnar collateral ligamentous complex is located just distal to the lateral epicondyle at the geometric center of the radiocapitellar articulation [11].
The distal humeral articulation is angled 30° from the longitudinal axis [11].
The anterior humeral line should pass through the center of the axis of rotation [11].
The axis of rotation is 5° to 7° angulated in the coronal plane to the epicondylar axis, with the medial side more distal than the lateral side [11].
The angulation of the distal humeral articulation accounts for the change from a valgus carrying angle to a more varus position as the elbow is flexed [11].
There is a high correlation between the size of the radius and capitellum on the left and right sides in the same individual [11].
The olecranon allows for a broad attachment site of the triceps [11].
The ulna medially bends approximately 8° at 8 cm from the tip of the olecranon [11].
The articulation to the tip of the coronoid is approximately 30° from the long axis of the ulna in the sagittal plane [11].
The radial head should line up with the capitellum at all arm positions on all radiographic views [12, 13].
Tensile forces are present at the medial elbow and compressive forces are present at the lateral elbow [12, 13].

Ligaments & Stability¶

Elbow stability is conferred by bony articular anatomy and ligamentous structures on the medial and lateral sides [9].
The three primary stabilizers of the elbow are the ulnohumeral articulation, the medial ulnar collateral ligament, and the lateral ulnar collateral ligament complex [9].
Secondary stabilizers of the elbow include the radiocapitellar articulation, the common flexor tendon, the common extensor tendon, and the joint capsule [9].
The lateral ulnar collateral ligament is the posterolateral stabilizer of the elbow [12, 13].
The medial or ulnar collateral ligament is the primary valgus stabilizer of the elbow [12, 13].
The anterior bundle of the medial ulnar collateral ligament is the most important component for stability [12, 13].
The posterior bundle of the medial ulnar collateral ligament has the greatest change in length and becomes taut at flexion beyond 120 degrees [12, 13].
The lateral ulnar collateral ligament arises from the epicondyle and inserts on the annular ligament [18].
A separate band of the lateral ligamentous complex, the lateral ulnar collateral ligament, arises at the lateral epicondyle and blends with fibers of the annular ligament before inserting on the tubercle on the crest of the supinator of the ulna [18].
The lateral ulnar collateral ligament is described as the main lateral stabilizer, taut in flexion and extension [18].
Disruption of the lateral ulnar collateral ligament results in posterolateral rotatory instability [18].
The lateral collateral ligament contributes 14% of the varus stability of the elbow with the joint in full extension [18].
The lateral collateral ligament contributes 9% of the varus stability of the elbow with the joint in 90 degrees of flexion [18].
The remainder of varus stability is contributed by the bony articular surfaces and the anterior capsule, with the bony surfaces providing the stability [18].
The ulnar collateral ligament plays an important role in valgus stability [18].
Valgus stability is divided equally among the ulnar collateral ligament, the anterior capsule, and the bony articulation with the elbow in full extension [18].
At 90 degrees of flexion, the ulnar collateral ligament provides 55% of the stability to valgus stress [18].
The anterior bundle of the ulnar collateral ligament is the primary stabilizer for valgus stress at 90 degrees of flexion [18].
The primary stabilizers of the elbow are the anterior band of the medial ulnar collateral ligament and the lateral collateral ligament complex, consisting of the lateral collateral ligament, annular ligament, and the lateral ulnar collateral ligament [18].
Secondary stabilizers consist of the capsule, the ulnohumeral and radiocapitellar articulations, and dynamic stabilizers consisting of all muscle-tendon units that cross the elbow joint [18].
Dynamic stabilizers include the biceps, brachialis, triceps, wrist flexors, and wrist extensors [18].
Insufficiency of one or more stabilizers may result in a spectrum of instability from subtle valgus or posterolateral rotatory instability to recurrent dislocation [18].
The typical injury pattern for traumatic elbow dislocation involves a fall on a slightly flexed extremity with a valgus internal rotation force of the forearm [18].
In traumatic elbow dislocation, structures are disrupted on the lateral side, progressing medially as more force is applied [18].
When recurrence or persistence in instability results from traumatic dislocation, the posterolateral structures are most commonly affected [18].
Medial structures can also be involved in traumatic dislocation and cause significant instability [18].
A coronoid fracture in association with disruption of the posterior band of the ulnar collateral ligament can result in symptomatic posteromedial instability [18].
Isolated medial side disruptions from valgus stress can result from football tackling, gymnastics, or throwing a javelin [18].
Valgus instability from attritional disruption of the anterior bundle of the medial ulnar collateral ligament is the most common form of recurrent elbow instability [18].
The anterior bundle of the medial ulnar collateral ligament is divided into two nonisometric bands: an anterior band taut at 0 to 60 degrees and a posterior band taut at 60 to 120 degrees [18].
During the acceleration phase of throwing, up to 60 N of force is applied to the medial ulnar collateral ligament, which is near its tensile failure point [18].
Pitcher fatigue, poor mechanics, or repetition overuse can result in bundle fiber failure, partial tearing, and eventual complete disruption of the medial ulnar collateral ligament [18].
Failure of the primary stabilizer results in increased stress on secondary stabilizers [18].
Increased stress on secondary stabilizers can result in capsular contractures, chondromalacia, osteophytes, and loose bodies from compression of the radiocapitellar joint and shear forces to the posteromedial tip of the olecranon [18].
Ulnar nerve symptoms may develop from traction, scarring, or osteophyte impingement following primary stabilizer failure [18].

Muscles & Soft Tissue¶

The brachialis is the strongest elbow flexor and attaches to the coronoid 11 mm distal to the tip [12, 13].
The biceps brachii inserts at the ulnar margin of the radial tuberosity, with the long head proximal and short head distal [12, 13].
The biceps brachii is a powerful supinator of the forearm [12, 13].
The primary elbow extensor, the triceps, inserts on the olecranon process [12, 13].
The mobile wad consists of the brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis [12, 13].
The flexor-pronator mass consists of the pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis [12, 13].
The common origin of the extensor muscles is attached to the lateral condyle and need not be disturbed in a lateral approach to a fracture of the lateral condyle [14].
The radial nerve enters the interval between the brachialis and brachioradialis muscles in the proximal angle of the lateral approach wound [14].
The deep branch of the radial nerve enters the supinator muscle and must be protected during lateral approach dissection [14].
The common extensor tendon is a secondary stabilizer of the lateral elbow [8].
The articular capsule is a secondary stabilizer of the lateral elbow [8].

Pathophysiology & Instability¶

Elbow instability may be congenital, traumatic, or attritional [18].
In a long-term follow-up study of simple elbow dislocations, 60% of patients had residual stiffness with loss of extension and residual pain [18].
In a long-term follow-up study of simple elbow dislocations, only 8% of patients had functional instability [18].
When fractures are associated with elbow dislocation, resulting in loss of bony stability provided by the greater sigmoid notch of the ulna or the radiocapitellar joint, greater instability and disability can be anticipated [18].
The docking technique for lateral ulnar collateral ligament reconstruction has shown recurrent instability rates as high as 25% [8].
Postoperative stiffness is a known complication of lateral ulnar collateral ligament reconstruction and occurs not uncommonly [8].

Classification¶

The docking technique originally described by Jones et al. in 2012 is the most common method in use in contemporary practice for LUCL reconstruction [8].
The docking technique has shown recurrent instability rates as high as 25% [8].
A knotless, onlay technique performs LUCL reconstruction with a tendon graft without violation of the extensor origin and soft tissue envelop [8].
The use of knotless anchors and an onlay technique shortens operative time, reduces the required surgical exposure, and removes the risk of tunnel osteolysis or fracture and resultant graft failure while maintaining a broad bone surface for graft incorporation [8].
Minimally-invasive dissection prevents iatrogenic injury to the common extensor origin, an important secondary stabilizer of the lateral elbow, and the articular capsule [8].
Remaining extracapsular with a minimally-invasive technique avoids plication of the capsular structures or risk of formation of intra-articular adhesions, theoretically reducing the risk of any postoperative loss of range of motion [8].

Clinical Presentation¶

Posterolateral rotatory instability of the elbow involves a complex spectrum of lateral-sided injuries [3].
High-grade atraumatic posterolateral rotatory instability is a clinical presentation managed by arthroscopic lateral collateral ligament reconstruction with tendon graft [6].
Subacute and chronic posterolateral rotatory instability is a clinical presentation managed by suture-augmented lateral ulnar collateral ligament and radial collateral ligament reconstruction [3].
Terrible triad injuries are a clinical presentation in which lateral ulnar collateral ligament repair using suture button fixation is indicated [5].

Investigations¶

Physical Examination¶

Elbow stability is determined by primary stabilizers (ulnohumeral articulation, MUCL, LUCL complex) and secondary stabilizers (radiocapitellar articulation, common flexor tendon, common extensor tendon, joint capsule) [9].
The normal elbow has a range of motion from 0° to 140° from extension to flexion and 75° and 85° in pronation and supination respectively [9].
A functional arc in each plane is 100° for flexion and extension and forearm rotation [9].
The physical exam is directed by history and the location of the patient's pain in the anterior, posterior, medial, or lateral aspect of the elbow [9].

Imaging¶

Plain radiographs remain the hallmark and the best screening test for elbow evaluation [9].
AP, lateral, and oblique radiographs are standard for elbow evaluation [17].
CT is helpful when assessing for malunion architecture and the location and pattern of osteophytes and/or loose bodies [17].
Three-dimensional CT is used to check for heterotopic ossification [17].
CT is not necessary when the stiffness is entirely soft-tissue related [17].
MRI can be used to evaluate ligaments and tendons, but it is rarely indicated for elbow stiffness [17].
Magnetic resonance evaluation of the elbow includes imaging of ligament complexes [16].
MR evaluation of instability patterns including the soft-tissue lesions that result from dislocation is emphasized [16].
MRI may be most helpful in evaluating associated injuries including partial or complete tears of the MCL in valgus extension overload syndrome [20].
CT with two-dimensional reconstruction and three-dimensional surface rendering best visualizes the pathology of valgus extension overload syndrome [20].
Radiographic evaluations are essential when diagnosing an OCD lesion of the elbow, however important aspects of the OCD lesions may be better seen with MRI [21].

Treatment¶

Arthroscopic Techniques¶

An all-arthroscopic reconstruction of the lateral ulnar collateral ligament is a reproducible technique that avoids residual instability [1].
Arthroscopic lateral ulnar collateral ligament plication or reconstruction with augmented lateral collateral ligament imbrication is a minimally invasive method that promotes quicker patient recovery and long-term functional restoration [4].
Arthroscopic lateral ulnar collateral ligament reconstruction with a tendon graft restores stability through a dynamic "sling effect" rather than rigid constraint [6].
Arthroscopic-assisted lateral ulnar collateral ligament reconstruction provides less insult and dissection to the soft tissue at the lateral side of the elbow [7].
Arthroscopic-assisted lateral ulnar collateral ligament reconstruction serves as an excellent tool to diagnose concomitant intraarticular pathologies [7].

Open and Mini-Invasive Techniques¶

Open posterolateral ligament plication and lateral ulnar collateral ligament repair using an all-suture construct allows for complete posterolateral stabilization of the elbow with a single implant and bone preservation [2].
Suture-augmented lateral ulnar collateral ligament and radial collateral ligament reconstruction provides a reproducible, anatomically based construct that restores posterolateral elbow stability [3].
Suture-augmented lateral ulnar collateral ligament and radial collateral ligament reconstruction addresses the complex spectrum of lateral-sided injuries observed in posterolateral rotatory instability [3].
A mini-invasive approach for lateral ulnar collateral ligament reconstruction uses a knotless, onlay technique that performs reconstruction without violation of the extensor origin and soft tissue envelop [8].
The knotless, onlay technique for lateral ulnar collateral ligament reconstruction shortens operative time and reduces the required surgical exposure [8].
The knotless, onlay technique for lateral ulnar collateral ligament reconstruction removes the risk of tunnel osteolysis or fracture and resultant graft failure while maintaining a broad bone surface for graft incorporation [8].
Minimally-invasive dissection for lateral ulnar collateral ligament reconstruction prevents iatrogenic injury to the common extensor origin and the articular capsule [8].
Minimally-invasive dissection for lateral ulnar collateral ligament reconstruction allows for earlier rehabilitation and return of range of motion, reduced postoperative pain, and reduced operative time [8].
Fluoroscopic guidance during minimally-invasive lateral ulnar collateral ligament reconstruction can help to reduce injuries to unintended structures [8].
Remaining extracapsular during lateral ulnar collateral ligament reconstruction avoids plication of the capsular structures and the risk of formation of intra-articular adhesions [8].
Remaining extracapsular during lateral ulnar collateral ligament reconstruction theoretically reduces the risk of postoperative loss of range of motion [8].

Specific Indications and Constructs¶

Suture button fixation for repair of the lateral ulnar collateral ligament in terrible triad injuries has not been previously described [5].

Complications¶

The docking technique for LUCL reconstruction has shown recurrent instability rates as high as 25% [8].
Postoperative stiffness is a known complication of LUCL reconstruction and occurs not uncommonly [8].
The use of a knotless, onlay technique removes the risk of tunnel osteolysis or fracture and resultant graft failure [8].
Minimally-invasive dissection prevents iatrogenic injury to the common extensor origin, an important secondary stabilizer of the lateral elbow [8].
Minimally-invasive dissection prevents iatrogenic injury to the articular capsule [8].
Remaining extracapsular with a minimally-invasive technique avoids plication of the capsular structures [8].
Remaining extracapsular with a minimally-invasive technique avoids the risk of formation of intra-articular adhesions [8].
Fluoroscopic guidance can help to reduce injuries to unintended structures that could be foreseen due to a limited exposure [8].

Recovery¶

The arthroscopic reconstruction of the lateral ulnar collateral ligament avoids residual instability [1].
The open posterolateral ligament plication and lateral ulnar collateral ligament repair technique allows for complete posterolateral stabilization of the elbow [2].
The open posterolateral ligament plication and lateral ulnar collateral ligament repair technique achieves bone preservation [2].
The suture-augmented lateral ulnar collateral ligament and radial collateral ligament reconstruction restores posterolateral elbow stability [3].
The arthroscopic lateral ulnar collateral ligament plication/reconstruction with augmented lateral collateral ligament imbrication promotes quicker patient recovery [4].
The arthroscopic lateral ulnar collateral ligament plication/reconstruction with augmented lateral collateral ligament imbrication promotes long-term functional restoration [4].
Reconstruction of the lateral ulnar collateral ligament with a tendon graft restores stability through a dynamic “sling effect” rather than rigid constraint [6].

Key Evidence¶

[L5] The presented arthroscopic technique is reproducible and achieves the reconstruction of the LUCL of the elbow as well as avoids residual instability. [1] (10.1016/j.eats.2024.103096)
[L5] The technique allows for complete posterolateral stabilization of the elbow with a single implant and bone preservation. [2] (10.1016/j.eats.2024.103172)
[L5] The described method provides a reproducible, anatomically based construct that restores posterolateral elbow stability and addresses the complex spectrum of lateral-sided injuries observed in PLRI. [3] (10.1016/j.eats.2025.103797)
[L5] This minimally invasive method allows effective management of elbow instability while promoting quicker patient recovery and long-term functional restoration. [4] (10.1016/j.eats.2025.103529)
[L4] The use of suture button fixation for repair of lateral ulnar collateral ligament has not been previously described. [5] (10.1016/j.eats.2023.10.004)
[L5] Reconstruction of the lateral ulnar collateral ligament with a tendon graft offers an alternative, restoring stability through a dynamic “sling effect” rather than rigid constraint. [6] (10.1002/atn2.70037)
[L5] It provides less insult and dissection to the soft tissue at the lateral side of the elbow while being an excellent tool to diagnose any concomitant intraarticular pathologies. [7] (10.1016/j.eats.2024.103101)
[L5] [8] (10.1002/atn2.70135)

References¶

[1] Posterolateral Elbow Dislocation: An All‐Arthroscopic Reconstruction of the Lateral Ulnar Collateral Ligament. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103096

[2] Open Posterolateral Ligament Plication and Lateral Ulnar Collateral Ligament Repair in Posterolateral Rotatory Instability of the Elbow Using an All‐Suture Construct. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103172

[3] Suture‐Augmented Lateral Ulnar Collateral Ligament and Radial Collateral Ligament Reconstruction for Subacute and Chronic Posterolateral Rotatory Instability. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103797

[4] Arthroscopic Lateral Ulnar Collateral Ligament Plication/Reconstruction With Augmented Lateral Collateral Ligament Imbrication. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103529

[5] Suture Button Repair for Lateral Ulnar Collateral Ligament in Terrible Triad Injuries: Surgical Technique. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2023.10.004

[6] Arthroscopic Lateral Collateral Ligament Reconstruction With Tendon Graft in High‐Grade Atraumatic Posterolateral Rotatory Instability in Elbows. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70037

[7] Arthroscopic‐Assisted Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Technical Note. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103101

[8] Lateral Ulnar Collateral Ligament Reconstruction Through a Mini‐Invasive Approach. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70135

[9] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Summary and Conclusions.

[11] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Anatomy > Bony Anatomy.

[12] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > TABLE 2.3 Shoulder Spaces.

[13] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > TABLE 2.3 Shoulder Spaces.

[14] Campbell S Operative Orthopaedics 4 Volume Set. LATERAL APPROACHES.

[16] Orthopaedic Knowledge Update Sports Medicine 6. Magnetic Resonance Imaging of the Elbow > Annotated References.

[17] Aaos Comprehensive Orthopaedic Review 3. Elbow Stiffness* > IV. Evaluation.

[18] Campbell S Operative Orthopaedics 4 Volume Set. POSTERIOR SURGICAL APPROACH FOR QUADRILATERAL SPACE SYNDROME > MCLAUGHLIN PROCEDURE > ARTHROSCOPIC SURGERY.

[20] Aaos Comprehensive Orthopaedic Review 3. Elbow Injuries in the Athlete* > III. Valgus Extension Overload Syndrome and Posterior Impingement.

[21] Orthopaedic Knowledge Update. Osteochondritis Dissecans of the Knee and Elbow* > Summary.

	CC Creative Commons licence
	BY Attribution — you must credit the source
	NC NonCommercial — not for commercial use