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Elbow Instability PDF Evidence

A hand-drawn illustration of a faceless person holding their elbow after it gave way in a fall.
Ligaments of the elbow — the ulnar and radial collateral ligaments are the main stabilisers. Kieran Hirpara 4.0

Elbow ligamentous and bony instability, including dislocation and the terrible-triad pattern.

What you're feeling

You may feel like your elbow is slipping out of place or giving way. This sensation often happens when you reach for objects or lift things. The pain can be sharp and sudden, or it might feel like a deep ache that lingers. You might notice the pain is worse after using your arm for daily tasks, such as tucking in a shirt or reaching behind your back to fasten a bra. Some people find that sleeping on the affected side makes the discomfort worse, while others feel stiffness when they first wake up in the morning.

The instability often stems from damage to the ligaments that hold your elbow bones together. These ligaments act like strong bands, keeping your joint stable. When they are injured, your elbow may not move smoothly. You might experience a feeling of looseness or a "catching" sensation as you bend or straighten your arm. This can make simple movements difficult. For example, turning a doorknob or pouring a glass of water might feel awkward or unsafe because you are unsure if your elbow will hold steady.

In some cases, the pain is not just in the joint itself but radiates down the forearm. You might confuse this with tennis elbow, which is pain on the outside of the elbow. However, if the pain persists despite rest, it could be linked to underlying instability. You may also notice swelling or warmth around the joint after activity. It is common to feel frustrated when everyday tasks become challenging. Your surgeon will help you understand exactly what is causing these symptoms through a careful examination and imaging tests.

If you have had a previous dislocation, you might be more aware of how your elbow moves. You may avoid certain positions to prevent the joint from shifting. This caution can lead to stiffness over time. You might find that you cannot fully straighten or bend your arm as you used to. This loss of motion can affect your ability to perform routine activities. Understanding these feelings is the first step toward getting the right treatment to restore stability and comfort.

What's actually happening

Your elbow is a complex hinge that relies on two types of support to stay steady. Static stabilizers are the bones and ligaments that act like strong ropes. Dynamic stabilizers are the muscles that pull to keep everything in place. These parts must work together in perfect sync. When they do not, your elbow becomes unstable.

This instability often involves damage to the bones and the ligamentous stabilizers. The ligaments are thick bands of tissue that hold the joint together. In many cases, the injury causes rotatory instability. This means the bones twist in abnormal directions, such as backward and to the side. Your surgeon must address these specific twisting forces to restore stability. If only one direction is treated, the elbow may still feel loose or painful.

The pain and feeling of giving way you experience come from this mechanical failure. Without proper support, the joint surfaces rub against each other incorrectly. This can increase pressure on the cartilage, which is the smooth coating on the bone ends. Over time, this wear-and-tear can lead to arthritis. The symptoms are your body’s signal that the structural integrity of the joint is compromised.

Sometimes, distinguishing between a healthy, flexible elbow and one that is truly unstable is difficult. Sonography alone cannot always make this distinction. This is why your surgeon relies on a complete clinical history and physical examination. They look for specific patterns of movement that indicate which stabilizers are failing.

Treatment aims to repair or replace these damaged supports. Ligament repairs can yield satisfactory outcomes, helping you regain a near full arc of motion. In more complex cases, reconstruction may be necessary to balance the joint forces. The goal is always to stop the abnormal twisting and restore the natural kinematics of your elbow.

What we can do about it

Your journey to stability begins with careful monitoring and gentle movement. For simple elbow dislocations, your surgeon will perform a detailed clinical assessment and order sequential radiographic follow-up. This ensures the joint is healing correctly without slipping out of place again. If your dislocation is simple, conservative treatment often leads to good clinical and functional results. You will work with a physiotherapist to restore motion. The goal is to regain a near full arc of elbow flexion and forearm rotation. You must give this process time. Patience is key as your ligaments heal and your muscles regain strength.

If pain or stiffness persists, your surgeon may discuss medical management options. These treatments aim to reduce inflammation and protect the joint while it heals. You might receive injections to help manage symptoms. Cortisone injections can reduce swelling and pain in the short term. Hyaluronic acid injections may help lubricate the joint, though evidence for long-term benefit varies. Platelet-rich plasma (PRP) injections use your own blood components to promote healing, but results can differ from person to person. These options do not fix structural instability, but they can make daily activities more comfortable while you focus on rehabilitation.

Surgery is considered when conservative care has reached its limit or when the instability is complex. If you have combined instability in both directions, surgery is necessary to restore stability. Your surgeon may repair the lateral collateral ligament using suture-tape augmentation or suture anchors. For late instability, they might reconstruct the ligament using a tendon graft from another part of your body. In severe cases where the elbow is stiff or ankylosed, a hinged external fixator may be used alongside repair. For patients with significant bone loss or ligamentous damage, a linked total elbow arthroplasty (joint replacement) may be preferred over an unlinked one to prevent further instability. While surgical outcomes can be satisfactory, treatments remain challenging. High rates of persistent instability, stiffness, or pain can occur in demanding cases. Your surgeon will discuss whether the benefits of surgery outweigh these risks for your specific situation.

What to expect

Your outlook depends largely on whether your elbow instability is simple or complex. Simple dislocations often settle well with conservative care. Most patients see their symptoms resolve completely. You can typically regain a near full arc of elbow flexion and forearm rotation. The functional results are generally good.

Complex instability involves more damage to the bones and ligaments that hold your joint together. This type is harder to treat. Even with modern techniques, outcomes can be challenging in demanding cases. You may face persistent instability, stiffness, pain, or post-traumatic arthritis. These issues can linger long after the initial injury.

If you have minor lateral elbow instability, you might find relief through specific procedures like ligament plication. At a two-year median follow-up, patients report subjective satisfaction and positive clinical results. For more severe cases requiring ligament repair or reconstruction, the goal is to restore stability. Suture-tape augmentation is one option that yields acceptable functional outcomes. The reoperation rate for these procedures is comparable to other joint stabilization surgeries.

It is important to know that long-term outcomes for complex elbow injuries remain unknown. We do not yet have enough data to predict what happens many years after surgery. In some cases, ligaments may not heal or tighten sufficiently over time. Problems can arise even up to five years after removing a radial head prosthesis.

If left alone, instability often persists. The elbow relies on static and dynamic stabilizers working in synchrony. When these fail, the joint becomes unreliable. Simple dislocations require detailed assessment and sequential radiographic follow-up to ensure proper healing. Complex cases often need surgical addressing of both posterolateral and posteromedial directions to restore stability.

Your surgeon will tailor the plan to your specific injury pattern. Whether you choose non-surgical management or surgery, close monitoring is essential. Sonography cannot objectively distinguish between healthy and hypermobile joints, so your clinical history and examination are vital. Be prepared for a recovery that requires patience. While many patients do well, some continue to experience symptoms. Your surgeon will help you navigate these possibilities with realistic expectations.

When to see someone

See your GP if you have persistent elbow pain that does not improve with rest. Ask for a specialist review if you feel weakness, instability, or if your joint locks or gives way. Seek care if symptoms interfere with your sleep or work. Sudden worsening after a traumatic event also requires attention. Complex instability involves important bone and ligament stabilizers. Simple dislocations need detailed clinical assessment and sequential radiographic follow-up. Sonography cannot objectively distinguish between healthy and hypermobile joints. A complete clinical history and examination are vital for accurate diagnosis.

Reviewed by AI synthesis (v2) — pending human review · 2026-05-18 19:02:24.900404+00:00.

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Evidence & references

title: "Elbow Instability" slug: elbow-instability region: elbow audience: patient mesh_terms: ["Joint Instability", "Elbow Joint", "Collateral Ligaments", "terrible triad", "posterolateral rotatory instability", "PLRI", "elbow dislocation"] article_count: 94 model_used: Qwen3.6-35B-A3B-Q8_0.gguf generated_at: '2026-06-14T15:33:13+00:00' key_articles: - title: "Complex instability of the elbow" ref_num: 1 evidence_tier: paper doi: 10.1016/j.injury.2013.09.032 year: 2017 - title: "Combined posterolateral and posteromedial rotatory instability of the elbow" ref_num: 2 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.injury.2007.01.039 year: 2007 - title: "Simple Elbow Dislocation" ref_num: 3 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.hcl.2015.06.002 year: 2015 - title: "Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing" ref_num: 4 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jhsa.2016.11.025 year: 2017 - title: "Lateral Collateral Ligament Instability of the Elbow" ref_num: 5 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.hcl.2007.11.001 year: 2008 - title: "Complex Elbow Instability" ref_num: 6 evidence_tier: paper evidence_level: 5 doi: 10.5435/00124635-200605000-00003 year: 2006 - title: "Does sonography allow an objective and reproducible distinction between stable, hypermobile, and unstable elbow joints?" ref_num: 7 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.jse.2020.11.023 year: 2021 - title: "Treatment of elbow instability: state of the art" ref_num: 8 evidence_tier: paper evidence_level: 5 doi: 10.1136/jisakos-2019-000316 year: 2021 - title: "Lateral Ulnar Collateral Ligament Repair With Suture-Tape Augmentation for Traumatic Elbow Instability" ref_num: 9 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jhsa.2022.10.016 year: 2023 - title: "Surgical Treatment of Posterolateral Rotatory Instability of the Elbow" ref_num: 10 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.arthro.2014.02.029 year: 2014 - title: "Ligamentous repair of acute lateral collateral ligament rupture of the elbow" ref_num: 11 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2013.06.018 year: 2013 - title: "Residual increased valgus stress angulation and posterolateral rotatory translation after simple elbow dislocation" ref_num: 12 evidence_tier: paper evidence_level: 4 doi: 10.1007/s00167-016-4176-0 year: 2016 - title: "Instability After Total Elbow Arthroplasty" ref_num: 13 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.hcl.2007.11.002 year: 2008 - title: "Magnetic Resonance Imaging Findings in Acute Elbow Dislocation: Insight Into Mechanism" ref_num: 14 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jhsa.2013.11.031 year: 2014 - title: "Valgus Extension Overload: Arthroscopic Decompression in the Supine‐Suspended Position" ref_num: 15 evidence_tier: paper doi: 10.1016/j.eats.2016.04.005 year: 2016 - title: "The posterolateral ligament of the elbow: anatomy and clinical relevance" ref_num: 16 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2023.08.033 year: 2024 - title: "Reconstruction of the lateral ulnar collateral ligament of the elbow: a comparative biomechanical study" ref_num: 17 evidence_tier: paper evidence_level: 5 doi: 10.1007/s00167-015-3627-3 year: 2015 - title: "Arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow (SMILE)" ref_num: 18 evidence_tier: paper evidence_level: 4 doi: 10.1007/s00167-017-4531-9 year: 2017 - title: "Lateral collateral ulnar ligament reconstruction techniques in posterolateral rotatory instability of the elbow: A systematic review" ref_num: 19 evidence_tier: paper evidence_level: 1 doi: 10.1016/j.injury.2020.11.010 year: 2022 - title: "Clinical Presentation of Posterolateral Rotatory Instability of the Elbow in Children" ref_num: 20 evidence_tier: paper evidence_level: 4 doi: 10.2106/jbjs.l.00623 year: 2013 - title: "Systematic Review of Elbow Instability in Association With Refractory Lateral Epicondylitis: Myth or Fact?" ref_num: 21 evidence_tier: paper evidence_level: 1 doi: 10.1177/0363546520980133 year: 2021 - title: "Alteration of Stress Distribution Patterns in Symptomatic Valgus Instability of the Elbow in Baseball Players" ref_num: 22 evidence_tier: paper evidence_level: 4 doi: 10.1177/0363546515624916 year: 2016 - title: "Elbow Lateral Collateral Ligament Injuries" ref_num: 23 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jhsa.2012.10.030 year: 2013 - title: "Stress Ultrasound Evaluation of Medial Elbow Instability in a Cadaveric Model" ref_num: 24 evidence_tier: paper evidence_level: 5 doi: 10.1177/0363546514542805 year: 2014 - title: "Delayed valgus instability and proximal migration of the radius after radial head prosthesis failure" ref_num: 25 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jse.2010.04.046 year: 2010 - title: "Lateral Elbow Laxity Is Affected by the Integrity of the Radial Band of the Lateral Collateral Ligament Complex: A Cadaveric Model With Sequential Releases and Varus Stress Simulating Everyday Activities" ref_num: 26 evidence_tier: paper evidence_level: 5 doi: 10.1177/03635465211018208 year: 2021 - title: "Importance of radial head on elbow kinematics: radial head prosthesis" ref_num: 27 evidence_tier: paper evidence_level: 5 doi: 10.1007/s00402-006-0164-z year: 2006 - title: "Biomechanical Characteristics of Osteochondral Defects of the Humeral Capitellum" ref_num: 28 evidence_tier: paper evidence_level: 5 doi: 10.1177/0363546513490652 year: 2013 - title: "The circumferential graft technique for treatment of multidirectional elbow instability: a comparative biomechanical evaluation" ref_num: 29 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jse.2015.07.016 year: 2016 - title: "A Biomechanical Comparison of 2 Hybrid Techniques for Elbow Ulnar Collateral Ligament Reconstruction" ref_num: 30 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jhsa.2014.07.040 year: 2014 - title: "The Wrightington Approach to the Radial Head: Biomechanical Comparison With the Posterolateral Approach" ref_num: 31 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jhsa.2007.08.009 year: 2007 - title: "The contribution of the posterolateral capsule to elbow joint stability: a cadaveric biomechanical investigation" ref_num: 32 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jse.2018.02.045 year: 2018 - title: "Intra-articular findings in symptomatic minor instability of the lateral elbow (SMILE)" ref_num: 33 evidence_tier: paper evidence_level: 3 doi: 10.1007/s00167-017-4530-x year: 2017 - title: "Effect of coronal shear fractures of the distal humerus on elbow kinematics and stability" ref_num: 34 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jse.2010.02.002 year: 2010 - title: "Testing of a Novel Method for Securing Ligaments Against Bone During Simultaneous Medial and Lateral Elbow Ligament Reconstruction" ref_num: 35 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jhsa.2023.02.008 year: 2024 - title: "Kinematics of the ligamentous unstable elbow joint after application of a hinged external fixation device: A cadaveric study" ref_num: 36 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jse.2006.07.012 year: 2007 - title: "Biomechanical Evaluation of the TightRope Versus Traditional Docking Ulnar Collateral Ligament Reconstruction Technique" ref_num: 37 evidence_tier: paper evidence_level: 5 doi: 10.1177/0363546513482567 year: 2013 - title: "Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?" ref_num: 38 evidence_tier: paper evidence_level: 3 doi: 10.1007/s11999-013-3331-x year: 2014 - title: "Stability of severely stiff elbows after complete open release: treatment by ligament repair with suture anchors and hinged external fixator" ref_num: 39 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2014.03.013 year: 2014 - title: "Valgus Laxity of the Ulnar Collateral Ligament of the Elbow in Collegiate Athletes" ref_num: 40 evidence_tier: paper evidence_level: 3 doi: 10.1177/03635465010290050601 year: 2001 - title: "Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature" ref_num: 41 evidence_tier: case_report evidence_level: 5 doi: 10.1007/s00402-005-0018-0 year: 2005 - title: "Direct Repair for Managing Acute and Chronic Lateral Ulnar Collateral Ligament Disruptions" ref_num: 42 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.jhsa.2014.02.011 year: 2014 synthesis_version: "v2" verifier_status: skipped

Overview

  • Complex instability of the elbow involves important osseous and ligamentous stabilizers [1].
  • Management protocols exist for common patterns of complex elbow injury [1].
  • Combined posterolateral and posteromedial rotatory instability requires surgical addressing of both directions to restore elbow stability [2].
  • Effective treatment of simple elbow dislocations requires a detailed clinical assessment [3].
  • Effective treatment of simple elbow dislocations requires sequential radiographic follow-up [3].
  • Patients with lateral collateral ligament instability had resolution of symptoms and regained a near full arc of elbow flexion and forearm rotation [5].
  • Long-term outcomes with surgical management of complex elbow injuries are unknown [6].
  • Treatments for elbow instability remain challenging in demanding cases, with high rates of persistent instability, post-traumatic arthritis, stiffness, and pain [8].
  • Ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in acceptable functional outcomes for complex elbow instability [9].
  • Ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in a reoperation rate comparable with other joint stabilization procedures for complex elbow instability [9].
  • Lateral collateral ligament repair provides satisfactory outcomes for acute posterolateral rotatory instability of the elbow [11].
  • Instability is the major complication of unlinked total elbow arthroplasty, often requiring revision [13].
  • Linked total elbow arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss [13].
  • All reconstruction methods for the lateral ulnar collateral ligament were able to sufficiently restore posterolateral rotatory stability of the elbow over the full range of motion [17].

Anatomy & Pathophysiology

  • The elbow consists of static and dynamic stabilizers that function in synchrony to prevent elbow instability [4].
  • Complex instability of the elbow involves important osseous and ligamentous stabilizers [1].
  • Both posterolateral and posteromedial rotatory instability directions must be addressed surgically to restore elbow stability [2].
  • A distinction between healthy and hypermobile elbow joints is not possible via sonography, making complete clinical history and examination vital [7].
  • Posterolateral rotatory instability (PLRI) of the elbow remains to be fully understood [10].
  • Varus loads simulating everyday activities produce changes in varus joint angulation that are linearly dependent on the applied moment and persist after release of lateral stabilizing structures [26].
  • Proper balancing and adequate bone resection from the radial head are mandatory for obtaining normal elbow kinematics during radial head arthroplasty [27].
  • Elbow valgus torque increases contact pressure in the radiocapitellar joint [28].
  • The circumferential graft technique for multidirectional elbow instability was evaluated for stability against valgus and varus/posterolateral rotatory forces [29].
  • Proximal docking and single-point fixation hybrid ulnar collateral ligament reconstructions provided sufficient joint stability and strength compared to intact elbows, except for the proximal docking method at low flexion angles [30].
  • The Wrightington approach to the radial head is biomechanically superior to the posterolateral approach regarding changes in elbow laxity after surgery to the radial head [31].
  • Radial head displacement is greater after a simulated osteochondral lesion (OCL) at 30° to 60° of flexion compared with the intact elbow, but not as great as seen with sectioning of the lateral collateral ligament complex (LCLC) [32].
  • The capitellum alone does not contribute to elbow stability, whereas the trochlea has an important role [34].
  • A novel method for securing ligaments against bone during simultaneous medial and lateral elbow ligament reconstruction successfully prevented graft slippage without excessive construct displacement during static and dynamic testing [35].
  • The Orthofix elbow external fixator stabilizes the ligamentous unstable elbow joint efficiently but decreases the range of motion and constrains extension [36].
  • Both TightRope (TR) and traditional docking (DO) ulnar collateral ligament reconstruction techniques restored native joint kinematics from 15 to 75 degrees of flexion under low loading conditions [37].

Classification

  • Complex instability of the elbow involves important osseous and ligamentous stabilizers [1].
  • Combined posterolateral and posteromedial rotatory instability requires surgical addressing of both directions to restore stability [2].
  • Simple elbow dislocations require detailed clinical assessment and sequential radiographic follow-up for effective treatment [3].
  • The elbow consists of static and dynamic stabilizers that function in synchrony to prevent instability [4].
  • Lateral collateral ligament instability can result in symptoms of instability that resolve with treatment, allowing near full arc of elbow flexion and forearm rotation [5].
  • Long-term outcomes with surgical management of complex elbow injuries are unknown [6].
  • Sonography does not allow an objective and reproducible distinction between healthy and hypermobile elbow joints [7].
  • Treatments for elbow instability remain challenging, with high rates of persistent instability, post-traumatic arthritis, stiffness, and pain in demanding cases [8].
  • Instability is the major complication of unlinked total elbow arthroplasty, often requiring revision [13].
  • Linked total elbow arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss [13].
  • Acute elbow dislocations are traumatic events often resulting in pan-ligamentous disruption, suggesting the most common injury pattern may begin with medial-sided ligamentous disruption [14].
  • The posterolateral ligament of the elbow has a significant role in the elbow's posterolateral stability [16].
  • Stress ultrasonography shows different amounts of gapping with sectioning of the medial elbow stabilizers [24].

Clinical Presentation

  • Complex instability of the elbow involves important osseous and ligamentous stabilizers [1].
  • Combined posterolateral and posteromedial rotatory instability requires surgical addressing of both directions to restore stability [2].
  • Effective treatment of simple elbow dislocations requires a detailed clinical assessment and sequential radiographic follow-up [3].
  • The elbow consists of static and dynamic stabilizers that function in synchrony to prevent instability [4].
  • Patients with lateral collateral ligament instability had resolution of symptoms and regained a near full arc of elbow flexion and forearm rotation [5].
  • Long-term outcomes with surgical management of complex elbow injuries are unknown [6].
  • Sonography cannot objectively distinguish between healthy and hypermobile elbow joints, making complete clinical history and examination vital [7].
  • Treatments for elbow instability remain challenging with high rates of persistent instability, post-traumatic arthritis, stiffness, and pain in demanding cases [8].
  • Patients after conservatively treated simple elbow dislocations show good clinical and functional results [12].
  • Acute elbow dislocations are traumatic events often resulting in pan-ligamentous disruption, suggesting the most common injury pattern may begin with medial-sided ligamentous disruption [14].
  • Elbow arthroscopy is a useful tool for managing valgus extension overload when conservative treatments have failed [15].
  • The posterolateral ligament of the elbow has a significant role in the elbow's posterolateral stability [16].
  • Posterolateral rotatory instability of the elbow exists in children but may be masked by contracture, with radiographs potentially showing evidence of instability [20].
  • Instability can coexist and may be associated with refractory lateral epicondylitis [21].
  • Symptomatic ulnar collateral ligament insufficiency in baseball players is associated with characteristic high-stress distribution patterns on the anterolateral part of the capitellum and the anterolateral part of the ulna [22].
  • Almost one half of patients suffering from recalcitrant lateral epicondylitis display signs of lateral ligamentous patholaxity [33].
  • Over 85% of patients with symptomatic minor instability of the lateral elbow (SMILE) demonstrate at least one intra-articular abnormality [33].

Investigations

  • Effective treatment of simple elbow dislocations requires a detailed clinical assessment [3].
  • Effective treatment of simple elbow dislocations requires sequential radiographic follow-up [3].
  • The elbow consists of static and dynamic stabilizers that function in synchrony to prevent elbow instability [4].
  • A distinction between healthy and hypermobile elbow joints is not possible using sonography [7].
  • Obtaining a complete clinical history and examination is vital because sonography cannot distinguish between healthy and hypermobile elbow joints [7].
  • Posterolateral rotatory instability of the elbow exists in children but may be masked by contracture [20].
  • Radiographs may show evidence of instability in children with posterolateral rotatory instability [20].
  • Instability can coexist and may be associated with refractory lateral epicondylitis [21].
  • Symptomatic ulnar collateral ligament insufficiency is associated with characteristic high-stress distribution patterns on the anterolateral part of the capitellum and the anterolateral part of the ulna [22].
  • Different amounts of gapping are seen on stress ultrasonography with sectioning of the medial elbow stabilizers [24].
  • No numerical value can confidently determine the pathologic status of the ulnar collateral ligament of the elbow when using stress radiography [40].
  • An MRI should be performed if healing does not occur by a reasonable time despite successful bony healing to assess potential cartilage damage [41].

Treatment

  • Effective treatment of simple elbow dislocations requires a detailed clinical assessment and sequential radiographic follow-up [3].
  • Patients after conservatively treated simple elbow dislocations show good clinical and functional results [12].
  • Both directions of instability must be addressed surgically to restore elbow stability in combined posterolateral and posteromedial rotatory instability [2].
  • Ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in acceptable functional outcomes and a reoperation rate comparable with other joint stabilization procedures for complex elbow instability [9].
  • Satisfactory outcomes are obtained with lateral collateral ligament repair for acute posterolateral rotatory instability of the elbow [11].
  • All patients in the series had resolution of their symptoms of instability and regained a near full arc of elbow flexion and forearm rotation following treatment for lateral collateral ligament instability [5].
  • R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up [18].
  • Both Jobe and Docking techniques are safe and effective in the treatment of posterolateral elbow instability [19].
  • Treatment of late instability is focused on lateral ligament reconstruction from the humerus to the ulna using tendon grafts with reasonably good outcomes [23].
  • Elbow arthroscopy is a useful tool for managing diseases of the elbow, including valgus extension overload, when conservative treatments have failed [15].
  • Ligament repair with suture anchors and hinged external fixator could be an option for treating ankylosed, severely or very severely stiff elbows after complete open release [39].
  • Instability is the major complication of unlinked total elbow arthroplasty, often requiring revision [13].
  • Linked arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss [13].
  • Despite progress in surgical techniques and rehabilitation, treatments for elbow instability remain challenging with high rates of persistent instability, post-traumatic arthritis, stiffness, and pain in demanding cases [8].
  • Long-term outcome with surgical management of complex elbow injuries is unknown [6].

Complications

  • Complex elbow instability involves important osseous and ligamentous stabilizers [1].
  • Combined posterolateral and posteromedial rotatory instability requires surgical addressing of both directions to restore stability [2].
  • Effective treatment of simple elbow dislocations requires detailed clinical assessment and sequential radiographic follow-up [3].
  • The elbow consists of static and dynamic stabilizers that function in synchrony to prevent instability [4].
  • Patients with lateral collateral ligament instability had resolution of symptoms and regained near full arc of elbow flexion and forearm rotation [5].
  • Long-term outcomes with surgical management of complex elbow injuries are unknown [6].
  • Sonography cannot objectively distinguish between healthy and hypermobile elbow joints, making complete clinical history and examination vital [7].
  • Ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament for complex elbow instability results in acceptable functional outcomes and a reoperation rate comparable with other joint stabilization procedures [9].
  • Posterolateral rotatory instability (PLRI) of the elbow remains to be fully understood [10].
  • Satisfactory outcomes were obtained with lateral collateral ligament repair for acute posterolateral rotatory instability of the elbow [11].
  • Patients after conservatively treated simple elbow dislocations show good clinical and functional results [12].
  • Instability is the major complication of unlinked total elbow arthroplasty, often requiring revision [13].
  • Linked arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss [13].
  • Acute elbow dislocations are traumatic events often resulting in pan-ligamentous disruption, suggesting the most common injury pattern may begin with medial-sided ligamentous disruption [14].
  • R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up [18].
  • Ligaments of the elbow may not heal or tighten sufficiently over time, and removal of a radial head prosthesis may give rise to problems, even up to 5 years after prosthetic removal [25].
  • Longer-term studies are required to ascertain whether the apparent benefits of radial head arthroplasty are offset by late complications such as loosening [38].

Recovery

  • Effective treatment of simple elbow dislocations requires a detailed clinical assessment and sequential radiographic follow-up [3].
  • Patients after conservatively treated simple elbow dislocations show good clinical and functional results [12].
  • Residual increased valgus stress angulation and posterolateral rotatory translation can occur after simple elbow dislocation [12].
  • Ligaments of the elbow may not heal or tighten sufficiently over time, and removal of a radial head prosthesis may give rise to stability problems even up to 5 years after prosthetic removal [25].
  • For complex elbow instability, ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in acceptable functional outcomes [9].
  • Ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament for complex elbow instability has a reoperation rate comparable with other joint stabilization procedures [9].
  • Direct repair of traumatic tears of the lateral ulnar collateral ligumant yields satisfactory outcomes for acute posterolateral rotatory instability of the elbow [11].
  • No significant difference in clinical outcome or range of motion was observed after direct repair of traumatic tears of the lateral ulnar collateral ligament between acute and delayed treatment cohorts [42].
  • R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up [18].
  • Treatment of late instability is focused on lateral ligament reconstruction from the humerus to the ulna using tendon grafts, which yields reasonably good outcomes [23].
  • All patients in a series of lateral collateral ligament instability cases had resolution of their symptoms of instability and regained a near full arc of elbow flexion and forearm rotation [5].
  • Treatments for elbow instability remain challenging with high rates of persistent instability, post-traumatic arthritis, stiffness, and pain in demanding cases [8].
  • Long-term outcome with surgical management of complex elbow injuries is unknown [6].

Key Evidence

  • [Paper] This article discusses the important osseous and ligamentous stabilizers of the elbow joint and provides management protocols for the common patterns of complex injury encountered by the practising surgeon. (10.1016/j.injury.2013.09.032)
  • [L4] Both directions of instability must be addressed surgically to restore elbow stability. (10.1016/j.injury.2007.01.039)
  • [L5] Effective treatment of simple elbow dislocations requires a detailed clinical assessment and sequential radiographic follow-up. (10.1016/j.hcl.2015.06.002)
  • [L5] The elbow consists of static and dynamic stabilizers that function in synchrony to prevent elbow instability. (10.1016/j.jhsa.2016.11.025)
  • [L4] All patients in the series had resolution of their symptoms of instability and regained a near full arc of elbow flexion and forearm rotation. (10.1016/j.hcl.2007.11.001)
  • [L5] Long-term outcome with surgical management of complex elbow injuries is unknown. (10.5435/00124635-200605000-00003)
  • [L3] Nevertheless, a distinction between healthy and hypermobile elbow joints is not possible, and therefore, obtaining a complete clinical history and examination is vital. (10.1016/j.jse.2020.11.023)
  • [L5] Despite progress in surgical techniques and rehabilitation, treatments for elbow instability remain challenging with high rates of persistent instability, post-traumatic arthritis, stiffness, and pain in demanding cases. (10.1136/jisakos-2019-000316)
  • [L4] For complex elbow instability, ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in acceptable functional outcomes and a reoperation rate comparable with other joint stabilization procedures. (10.1016/j.jhsa.2022.10.016)
  • [L4] PLRI of the elbow remains to be fully understood. (10.1016/j.arthro.2014.02.029)
  • [L4] We obtained satisfactory outcomes with lateral collateral ligament repair for acute posterolateral rotatory instability of the elbow. (10.1016/j.jse.2013.06.018)
  • [L4] Patients after conservatively treated simple elbow dislocations show good clinical and functional results. (10.1007/s00167-016-4176-0)
  • [L4] Instability is the major complication of unlinked total elbow arthroplasty, often requiring revision, whereas linked arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss. (10.1016/j.hcl.2007.11.002)
  • [L4] Acute elbow dislocations are traumatic events often resulting in pan-ligamentous disruption, suggesting that the most common injury pattern may begin with a medial-sided ligamentous disruption. (10.1016/j.jhsa.2013.11.031)
  • [Paper] Elbow arthroscopy is a useful tool for managing diseases of the elbow, including valgus extension overload, when conservative treatments have failed. (10.1016/j.eats.2016.04.005)
  • [L4] The PLL of the elbow has a significant role in the elbow's posterolateral stability. (10.1016/j.jse.2023.08.033)
  • [L5] All reconstruction methods were able to sufficiently restore posterolateral rotatory stability of the elbow over the full range of motion. (10.1007/s00167-015-3627-3)
  • [L4] R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with a symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up. (10.1007/s00167-017-4531-9)
  • [L1] This systematic review showed that both Jobe and Docking techniques are safe and effective in the treatment of posterolateral elbow instability. (10.1016/j.injury.2020.11.010)
  • [L4] Posterolateral rotatory instability of the elbow exists in children but may be masked by contracture; radiographs may show evidence of instability. (10.2106/jbjs.l.00623)
  • [L1] Instability can coexist and may be associated with refractory lateral epicondylitis. (10.1177/0363546520980133)
  • [L4] Symptomatic UCL insufficiency was associated with characteristic high-stress distribution patterns on the anterolateral part of the capitellum and the anterolateral part of the ulna. (10.1177/0363546515624916)
  • [L5] Treatment of late instability is focused on lateral ligament reconstruction from the humerus to the ulna using tendon grafts with reasonably good outcomes. (10.1016/j.jhsa.2012.10.030)
  • [L5] The results suggest that different amounts of gapping are seen on stress ultrasonography with sectioning of the medial elbow stabilizers. (10.1177/0363546514542805)
  • [L5] This case illustrates that sometimes ligaments of the elbow may not heal or tighten sufficiently over time and that despite a careful examination elbow and forearm stability, removal of a radial head prosthesis may give rise to problems, even up to 5 years after prosthetic removal. (10.1016/j.jse.2010.04.046)
  • [L5] Varus loads simulating everyday activities produce changes in the varus joint angulation of the elbow that are linearly dependent on the applied moment and persist after release of the lateral stabilizing structures. (10.1177/03635465211018208)
  • [L5] Proper balancing and adequate bone resection from radial head is mandatory for obtaining normal elbow kinematics during the radial head arthroplasty procedure. (10.1007/s00402-006-0164-z)
  • [L5] Elbow valgus torque increases contact pressure in the radiocapitellar joint. (10.1177/0363546513490652)
  • [L5] The study evaluated stability against valgus and varus/posterolateral rotatory forces in cadaveric elbows. (10.1016/j.jse.2015.07.016)
  • [L5] Both the proximal docking and the single-point fixation hybrid reconstructions provided sufficient joint stability and strength compared to the intact elbows, with the exception of the proximal docking method at low flexion angles. (10.1016/j.jhsa.2014.07.040)
  • [L5] These results suggest that the newly described Wrightington approach is biomechanically superior to the posterolateral approach with regard to changes in elbow laxity after surgery to the radial head. (10.1016/j.jhsa.2007.08.009)
  • [L5] The degree of radial head displacement is greater after a simulated OCL at 30° to 60° of flexion compared with the intact elbow but not as great as seen with sectioning of the LCLC. (10.1016/j.jse.2018.02.045)
  • [L3] Almost one half of patients suffering from recalcitrant lateral epicondylitis display signs of lateral ligamentous patholaxity, and over 85% demonstrate at least one intra-articular abnormality. (10.1007/s00167-017-4530-x)
  • [L5] While the capitellum alone does not contribute to elbow stability, the trochlea has an important role. (10.1016/j.jse.2010.02.002)
  • [L5] This method of fixation to the proximal ulna for the simultaneous reconstruction of medial and lateral elbow ligaments successfully prevented graft slippage without excessive construct displacement during static and dynamic testing. (10.1016/j.jhsa.2023.02.008)
  • [L5] The Orthofix elbow external fixator stabilizes the ligamentous unstable elbow joint efficiently but at the expense of changes in the normal motion pattern, specifically decreasing the range of motion and constraining extension. (10.1016/j.jse.2006.07.012)
  • [L5] Both the TR and DO techniques restored native joint kinematics from 15 to 75 degrees of flexion under low loading conditions. (10.1177/0363546513482567)
  • [L3] Longer-term studies will be required to ascertain whether the apparent benefits of radial head arthroplasty are offset by late complications of arthroplasty, such as loosening. (10.1007/s11999-013-3331-x)
  • [L4] This could be an option for treating ankylosed, severely or very severely stiff elbows. (10.1016/j.jse.2014.03.013)
  • [L3] No numerical value can confidently determine the pathologic status of the ulnar collateral ligament of the elbow when using stress radiography. (10.1177/03635465010290050601)
  • [Case_report] The authors recommend performing an MRI if healing does not occur by a reasonable time despite successful bony healing to assess potential cartilage damage. (10.1007/s00402-005-0018-0)
  • [L3] No significant difference in clinical outcome or range of motion was observed after direct repair of traumatic tears of the lateral ulnar collateral ligament between acute and delayed treatment cohorts. (10.1016/j.jhsa.2014.02.011)

References

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The American Journal of Sports Medicine. 2001. DOI: 10.1177/03635465010290050601 [41] Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature. Archives of Orthopaedic and Trauma Surgery. 2005. DOI: 10.1007/s00402-005-0018-0 [42] Direct Repair for Managing Acute and Chronic Lateral Ulnar Collateral Ligament Disruptions. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.011

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