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Elbow Ligament Reconstruction (Stabilisation)

49 citationsUpdated Aug 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Determining which structures require repair is critical to avoid complications that could lead to elbow instability [1]. Evidence supports the use of elbow ligament repairs and reconstructions in both acute and chronic settings [3]. Elbow range of motion is reliably preserved or improved following ulnar collateral ligament (UCL) repairs and reconstructions [2]. This range of motion follows a predictable trajectory of rapid improvement within the first 2 to 4 months following UCL repairs and reconstructions [2].

Elbow ligament reconstruction by the technique of O'Driscoll et al effectively restores stability in the long term [7]. This technique also limits progression to osteoarthritis in the long term [7]. Similarly, elbow ligament reconstruction according to the technique of O'Driscoll gives effective posterolateral stabilization [21]. It appears to protect against progression to osteoarthritic degeneration in the long term [21].

Treatment of recurrent elbow instability with collateral ligament reconstruction and a temporary hinged internal fixator may be a viable surgical option to achieve stability, restore function, and preserve quality of life [5]. Ligament repair with suture tape augmentation for post-traumatic elbow instability achieves favorable outcomes in both acute and chronic presentations [9]. Injury chronicity does not affect outcomes following ligament repair with suture tape augmentation for post-traumatic elbow instability [9]. Ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in acceptable functional outcomes for complex elbow instability [11]. This approach results in a reoperation rate comparable with other joint stabilization procedures for complex elbow instability [11].

Current evidence regarding the optimal elbow flexion angle for graft fixation possesses a high degree of fragility [6]. Further studies with objective measurements are needed to determine the optimal elbow flexion angle for graft fixation [6].

Anatomy & Pathophysiology

Osseous

Restoration of osseous anatomy, particularly the coronoid, is a priority in restoring elbow alignment and maintaining ulnohumeral joint stability [13].

Ligamentous

Isolated displaced type II partial articular radial head fractures are correlated with lateral ulnar collateral ligament tears [1]. Ulnar collateral ligament reconstruction has inferior biomechanical properties compared with the native intact ligament at time zero [38]. Dynamic analyses using a 3-dimensional elbow model showed that none of the configurations for double-strand lateral ulnar collateral ligament reconstruction were isometric [23].

Classification

Outcome Assessment: Degenerative joint changes in elbow reconstruction outcomes are classified according to the Broberg and Morrey method, recording osteophytes on the medial ulnohumeral side and capitulum changes [45]. Periarticular ossifications in elbow reconstruction outcomes are rated according to the Hastings and Graham classification for heterotopic ossifications of the upper limb [45]. Modified Jobe versus Docking technique for elbow ulnar collateral ligament reconstruction outcomes are evaluated using a binary modification of the Conway Scale, recording "excellent" results as the ability to return to the same or higher level of play for at least a year [47].

Other Considerations: Elbow range of motion is reliably preserved or improved following ulnar collateral ligament repairs and reconstructions, with rapid improvement within the first 2 to 4 months [2]. Elbow ligament repairs and reconstructions are evidence-supported for both acute and chronic settings [3]. Novel bidirectional ligament reconstruction maintains secure fixation between ligament and bone and preserves static stability at different degrees of elbow flexion [4]. Collateral ligament reconstruction combined with a temporary hinged internal fixator is a viable surgical option for treating recurrent elbow instability in patients with Ehlers-Danlos syndrome [5]. Lateral elbow ligament reconstruction using the O'Driscoll et al. technique effectively restores stability and limits progression to osteoarthritis in the long term for posterolateral rotatory instability [7]. Novel uncemented elbow hemiarthroplasty stabilized with ligament reconstruction maintains secure fixation and static stability at varying degrees of elbow flexion, regardless of mismatch between the component and native olecranon fossa [8]. 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 [11]. Restoration of osseous anatomy, particularly the coronoid, is a priority for restoring elbow alignment and maintaining ulnohumeral joint stability in postoperative elbow instability [13]. The External Joint Stabilizer – Elbow (EJS-E) via the posterior approach can restore mobility and stability in patients with persistent elbow instability [14]. Arthroscopic repair of the lateral ulnar collateral ligament using a knotless suture anchor is minimally invasive and allows intra-articular visualization and treatment of concomitant pathology [15]. Arthroscopic repair of the lateral ulnar collateral ligament allows for visualization of joint reduction and assessment of stability after repair [15]. Arthroscopic lateral ulnar collateral ligament repair is technically challenging and requires good integrity of the avulsed ligament; if the ligament is poor quality or frayed, an open technique is recommended [15]. Not all lateral collateral ligament tears are amenable to arthroscopic repair, and conversion to open repair or reconstruction may be required if the humeral insertion is frayed [15]. In cases where the humeral insertion of the lateral collateral ligament is frayed, repairing the common extensor origin insertion is usually sufficient to restore elbow stability [15]. Lateral ulnar collateral ligament reconstruction for chronic posterolateral rotatory instability has an average time between injury and surgery of 31.8 months (range, 2 weeks to 180 months) [17]. Patients requiring revision lateral ulnar collateral ligament reconstruction surgery waited an average of 32.2 months (range, 4-108 months) between injury and surgery [17]. Patients with traumatic elbow instability treated with or without an internal joint stabilizer revealed similar elbow range of motion in the first 6 months [18]. Elbow ulnar collateral ligament shoelace repair with internal bracing may be useful for treating ulnar collateral ligament instability in throwing athletes with Little League elbow [20]. The internal joint stabilizer is a safe and effective implant that complements the management of chronic elbow dislocations [22]. In a prospective study of acute elbow dislocations, seven patients had clinically unidirectional collateral ligament instability with concurrent bony fracture, and four patients had clinical collateral ligament instability without bone fractures [24]. All patients in a prospective study of acute elbow dislocations demonstrated at least one collateral ligament injury on MRI scans, with the lateral collateral ligament being the most often involved [24]. A dual internal joint stabilizer system provided an innovative framework for managing severe elbow instability patterns while ensuring greater joint stability [28]. Use of an internal joint stabilizer allows for early, congruent, and stable ulnohumeral and radiocapitellar range of motion in instances of persistent elbow instability [31]. Surgical reconstruction of the lateral ulnar collateral ligament with autogenous tendon graft was performed on 14 patients with posterolateral rotatory instability, with a mean time between injury and surgery of 45 months (range: 4–108) [42]. In a study of posterolateral rotatory instability, five elbows presented with stage 1 instability, six with stage 2, two with stage 3a, and one with stage 3b [42]. Transposition of the local extensor fascia for lateral collateral ligament reconstruction involves tying graft sutures with correct tension with the elbow in 40° of flexion and the forearm fully pronated [45].

Clinical Presentation

History: Posterolateral rotatory instability is a clinical syndrome caused by lateral ulnar collateral ligament insufficiency, presenting with clicking, locking, or recurrent dislocation [30]. Atraumatic posterolateral rotatory instability should be considered in the differential diagnosis of lateral elbow pain when patients present with a protracted clinical course [29]. Isolated displaced type II partial articular radial head fractures are correlated with intraoperative findings of lateral ulnar collateral ligament tears [1].

Chronic Presentation: In a cohort of 81 patients with chronic lateral collateral ligament insufficiency, 76.5% presented with lateral or posterolateral elbow pain, 11.1% reported instability symptoms, 4.9% had medial or posteromedial elbow pain, 6.2% had anterior or anterolateral elbow pain, and 2.5% presented with elbow stiffness [34]. In a systematic review of 168 patients undergoing lateral ulnar collateral ligament reconstruction for chronic posterolateral rotatory instability, the population had a male predominance (97 male patients vs 66 female patients) [17]. Posterolateral rotatory instability occurred mostly in the left elbow (49 left elbows and 41 right elbows) and on the nondominant arm (53 nondominant elbows and 46 dominant elbows) [17].

Operative Context: In the same systematic review, 18 of 93 patients (19.4%) had additional procedures alongside their lateral ulnar collateral ligament reconstruction [17]. The average time between injury and surgery was 31.8 months (range, 2 weeks to 180 months) [17]. Patients who needed a revision reconstruction surgery waited an average of 32.2 months (range, 4-108 months) [17]. The mean follow-up time was 34.2 months (range, 2-145 months) [17].

Acute Injury: In a prospective study of patients with acute elbow dislocation, seven patients had at least clinically unidirectional collateral ligament instability with a concurrent bony fracture, and four patients had no bone fractures but demonstrated clinical collateral ligament instability [24]. All patients demonstrated at least one injury of the collateral ligament on MRI scans, with the lateral collateral ligament being the most often involved [24].

Treatment

Non-Operative

The provided evidence does not support specific non-operative conservative options such as weight loss, physical therapy, NSAIDs, or injections for this section.

Operative

Indications: Determining which structures require repair is critical to avoid complications that could lead to elbow instability [1]. Elbow ligament repairs and reconstructions demonstrate efficacy in both acute and chronic settings [3]. In acute trauma, fractures are initially addressed, followed by ligament repair or reconstruction [43]. For chronic elbow disease, capsular and bony release combined with bone and ligamentous reconstruction is undertaken [43]. Ligament repair with suture tape internal brace augmentation for traumatic elbow instability achieves favorable outcomes in both acute and chronic presentations, as injury chronicity does not affect outcomes [9].

Surgical Approach / Technique: Elbow range of motion is reliably preserved or improved following ulnar collateral ligament (UCL) repairs and reconstructions, with a predictable trajectory of rapid improvement within the first 2 to 4 months [2]. Elbow ligament reconstruction by the technique of O'Driscoll et al effectively restores stability and limits progression to osteoarthritis in the long term for posterolateral rotatory instability [7]. Lateral ulnar collateral ligament reconstruction for posterolateral rotatory instability can be performed in a reliable, efficient, and reproducible manner when precise surgical steps are followed [40]. An anconeus-sparing minimally invasive approach for lateral ulnar collateral ligament reconstruction allows accurate graft placement and fixation with maximal protection of the active elbow stabilizers like the common extensor tendons and the anconeus muscle [39].

Arthroscopic repair allows the surgeon to visualize the reduction of the elbow joint and assess stability after the ligament repair [15]. However, arthroscopic repair is technically challenging and requires good integrity of the avulsed lateral collateral ligament; if the ligament is poor quality and frayed, an open technique is recommended [15]. Not all lateral collateral ligament tears are amenable to arthroscopic repair, and intraoperative assessment is necessary to determine appropriateness, with conversion to open repair or reconstruction required if not amenable [15]. If the humeral insertion of the lateral collateral ligament is frayed and of poor quality, repairing the common extensor origin insertion is usually sufficient in restoring elbow stability [15].

For internal joint stabilizer use, the surgery can be performed with the patient in supine, lateral, or prone positions [43]. Temporary ischemia is achieved with a sterile tourniquet applied to the upper arm during internal joint stabilizer surgery [43]. A 1.5-mm Kirschner wire is placed on the axis of ulnohumeral rotation of the distal humerus to leave the center of rotation on the lateral capitellum free for the axis pin [43]. An aiming guide allows the connection of the isometric point on the lateral epicondyle to a medial point on the trochlear notch for accurate axis recreation [43]. Elbow stability is assessed throughout the range of motion, and residual instability is considered an indication for temporary stabilization with an internal joint stabilizer [43]. The likely need of temporary and additional stabilization with an internal joint stabilizer is generally considered at the beginning of surgery [43].

Implant Selection: Repair and augmentation of the lateral collateral ligament complex using internal bracing in dislocations and fracture dislocations of the elbow restores stability and allows early rehabilitation [12]. An internal joint stabilizer with a standardized treatment protocol could maintain concentric reduction while allowing early functional motion and improve clinical outcomes for patients with complex persistent elbow instability [10]. When augmenting surgical fixation for elbow instability, the internal joint stabilizer may be preferable for patients with complex comorbidities or social dynamics [32]. Biomechanical and clinical outcomes show that an external joint stabilizer via the posterior approach can restore mobility and stability in all patients, serving as a valuable alternative option for the treatment of persistent instability of the elbow [14].

A novel bidirectional ligament reconstruction maintained secure fixation between ligament and bone and allowed for maintenance of static stability at different degrees of elbow flexion [4]. Cadaveric elbow specimens maintained secure fixation between ligament and bone following hemiarthroplasty and ligament reconstruction, with static stability maintained at varying degrees of elbow flexion regardless of variable mismatch between the hemiarthroplasty component and the native olecranon fossa [8]. 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 [19]. Fascia lata allograft seems an appropriate treatment option for ligamentous reconstruction of chronic elbow instability due to its demonstration of sufficient biomechanical properties [25]. Elbow ulnar collateral ligament shoelace repair with internal bracing may be useful in the treatment of UCL instability along with a Little League elbow in throwing athletes [20].

Graft harvest for ulnar collateral ligament reconstruction with double suspensory fixation involves a 1-cm transverse incision over the palmaris at the wrist crease, with care to ensure the median nerve is not accidentally harvested [46]. The tendon should be harvested as close to the muscle-tendon belly interface as possible to maximize graft length [46]. The graft is cut under tension and sutured with #2 high-strength suture in a Krakow stitch 2 cm in length [46]. A button is toggled down to sit firmly against the graft, and the toggling sutures are tied to each other to prevent the button from backing up [46]. If the graft is of insufficient length, it is folded once for double thickness (2-ply) [46]. A curved 5-cm incision is made over the medial epicondyle for the approach, with blunt dissection to identify and protect branches of the medial antebrachial cutaneous nerves [46]. A splitting approach through the flexor carpi ulnaris ("ulnar window") is used in line with the muscle fibers [46].

Pain Management: The provided evidence does not specify analgesia regimens for this section.

Adjuncts: The provided evidence does not specify adjuncts such as tranexamic acid, drains, navigation, or robotics for this section.

Setting of Care: The provided evidence does not specify outpatient versus inpatient setting preferences for this section.

Revision: Internal joint stabilizer removal involves raising flaps with cutaneous and subcutaneous layers to gain exposition to the posterolateral elbow [44]. If an anconeus flap covered the whole internal device, hardware removal needs two small windows to be opened: one smaller on the lateral epicondyle to expose the axial pin and one larger on the ulnar plate [44]. Hardware removal involves unlocking the connection between the axial pin and the lateral connecting arm, followed by removal of proximal and distal locking screws [44]. The ulnar base plate is approached, and the three screws and plate are sequentially removed during internal joint stabilizer removal [44]. The joint is thoughtfully evaluated in range of motion and stability after any hardware is removed [44].

Other Considerations: The optimal elbow flexion angle for graft fixation requires further studies with objective measurements due to the high degree of fragility in current evidence [6]. Patients who experience medial elbow pain during the return-to-throwing period after ulnar collateral ligament reconstruction in pitchers are at increased risk for further surgical intervention [51].

Complications

Instability: Failure to correctly identify structures requiring repair preoperatively can result in elbow instability [1]. The optimal elbow flexion angle for graft fixation during ulnar collateral ligament reconstruction is not definitively established due to the fragility of current evidence [6]. There is a distinct difference in the complication profile between external fixation and the Internal Joint Stabilizer (IJS) when used for traumatic elbow instability [62].

Nerve palsy: Postoperative ulnar nerve complications occur in 12.0% of ulnar collateral ligament reconstruction surgeries [59].

Implant-specific complications: The Internal Joint Stabilizer (IJS) is associated with a 17% rate of removal at early follow-up [52]. Use of the IJS may result in possibly inferior forearm rotation [52].

Graft site morbidity: Graft site morbidity occurs in 1% of patients following ulnar or lateral collateral ligament reconstruction [53].

Revision rates: Revision rates for ulnar collateral ligament reconstruction with allograft appear greater than with autograft, though this may be secondary to limited allograft literature [58].

Other Considerations: Primary lateral ulnar collateral ligament reconstruction for posterolateral rotatory instability has a perioperative complication rate exceeding 15% [61].

Recovery

Light activity (weeks): Early functional motion is facilitated by specific stabilization techniques. An internal joint stabilizer with a standardized treatment protocol allows early functional motion in patients with complex persistent elbow instability [10]. Similarly, repair and augmentation of the lateral collateral ligament complex using internal bracing in dislocations and fracture dislocations of the elbow allows early rehabilitation [12].

Full activity (months): There is a predictable trajectory of rapid improvement in elbow range of motion within the first 2 to 4 months following UCL repairs and reconstructions [2]. Augmented UCL repair is associated with modest time to return [49].

Complete recovery / outcome plateau (months): Females demonstrated favorable clinical outcomes at a mean follow-up of 6 years following operative management of posterolateral rotatory instability [41]. A majority of female elbows returned to a preinjury level of function and sport regardless of whether they underwent primary or revision surgery for posterolateral rotatory instability [41].

Rehabilitation protocol: Treatment of recurrent elbow instability with collateral ligament reconstruction and a temporary hinged internal fixator may be a viable surgical option to achieve stability [5]. The novel bidirectional ligament reconstruction maintained secure fixation between ligament and bone [4]. Current evidence possesses a high degree of fragility regarding the optimal elbow flexion angle for graft fixation in ulnar collateral ligament reconstruction [6]. Further studies with objective measurements are needed to determine the optimal elbow flexion angle for graft fixation in ulnar collateral ligament reconstruction [6].

Functional milestones: Augmented UCL repair demonstrated excellent return to previous level of play [49]. Augmented UCL repair demonstrated excellent Kerlan Jobe Orthopaedic Clinic scores [49]. An internal joint stabilizer with a standardized treatment protocol could improve clinical outcomes for patients with complex persistent elbow instability [10]. Treatment of recurrent elbow instability with collateral ligament reconstruction and a temporary hinged internal fixator may be a viable surgical option to restore function [5]. Treatment of recurrent elbow instability with collateral ligament reconstruction and a temporary hinged internal fixator may be a viable surgical option to preserve quality of life [5].

Other Considerations: Arthroscopic partial excision for radial head comminuted fractures involving <50% of the articular surface is an effective and acceptable treatment for elbow fracture-dislocation when combined with coronoid fracture fixation and lateral collateral ligament complex repair [55]. Augmented UCL repair is associated with modest complications [49].

Key Evidence

  • [L3] It is important to determine which structures need to be repaired to avoid complications that could lead to elbow instability. [1] (10.1016/j.jse.2019.07.006)
  • [L4] Following UCL repairs and reconstructions, elbow ROM is reliably preserved or improved with a predictable trajectory of rapid improvement within the first 2 to four months. [2] (10.1016/j.jse.2025.10.002)
  • [L4] This study provides evidence for elbow ligament repairs and reconstructions in both acute and chronic settings. [3] (10.1016/j.jseint.2024.02.013)
  • [L5] This novel ligament reconstruction maintained secure fixation between ligament and bone and allowed for maintenance of static stability at different degrees of elbow flexion. [4] (10.1016/j.jhsg.2023.02.003)
  • [L5] Treatment of recurrent elbow instability with collateral ligament reconstruction and a temporary hinged internal fixator may be a viable surgical option to achieve stability, restore function, and preserve quality of life. [5] (10.2106/jbjs.cc.19.00355)
  • [L4] However, the available current evidence possesses a high degree of fragility, and further studies are needed with objective measurements to determine the optimal elbow flexion angle for graft fixation. [6] (10.1016/j.jse.2018.07.029)
  • [L4] Elbow ligament reconstruction by the technique of O'Driscoll et al effectively restores stability and limits progression to osteoarthritis in the long term. [7] (10.1016/j.jseint.2022.12.009)
  • [L5] Cadaveric elbow specimens maintained secure fixation between ligament and bone following hemiarthroplasty and ligament reconstruction, with static stability maintained at varying degrees of elbow flexion regardless of variable mismatch between the hemiarthroplasty component and the native olecranon fossa. [8] (10.1016/j.jse.2023.07.037)
  • [L3] Ligament repair with suture tape internal brace augmentation for traumatic elbow instability achieves favorable outcomes in both acute and chronic presentations. [9] (10.1016/j.jse.2025.11.011)
  • [L4] An internal joint stabilizer with a standardized treatment protocol could maintain concentric reduction while allowing early functional motion and improve clinical outcomes for patients with complex persistent elbow instability. [10] (10.1097/corr.0000000000002159)
  • [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. [11] (10.1016/j.jhsa.2022.10.016)
  • [L4] [12] (10.1007/s00167-019-05402-9)
  • [L5] Restoration of osseous anatomy, particularly the coronoid, is a priority in restoring elbow alignment and maintaining ulnohumeral joint stability. [13] (10.1016/j.jhsa.2023.10.015)
  • [L4] Biomechanical and clinical outcomes show that EJS-E via the posterior approach can restore mobility and stability in all patients, thus serving as a valuable alternative option for the treatment of persistent instability of the elbow. [14] (10.1186/s12891-022-06103-0)
  • [Paper] [15] (10.1016/j.eats.2017.08.057)
  • [Paper] [17] (10.1177/0363546520927412)
  • [L3] Patients with traumatic elbow instability treated with or without the IJS revealed similar elbow ROM in the first 6 months. [18] (10.1016/j.jse.2025.03.012)
  • [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. [19] (10.1016/j.jhsa.2023.02.008)
  • [Paper] This technique may be useful in the treatment of UCL instability along with a Little League elbow in throwing athletes. [20] (10.1016/j.eats.2021.04.008)
  • [L4] Elbow ligament reconstruction according to the technique of O'Driscoll gives effective posterolateral stabilization and appears to protect against progression to osteoarthritic degeneration in the long term. [21] (10.1016/j.jse.2023.01.011)
  • [L4] The internal joint stabilizer is a safe and effective implant that complements the management of chronic elbow dislocations. [22] (10.1016/j.xrrt.2022.02.001)
  • [L5] Dynamic analyses using a 3-dimensional elbow model showed that none of the configurations for double-strand LUCL reconstruction were isometric. [23] (10.1016/j.jse.2018.11.070)
  • [L4] [24] (10.1016/j.jisako.2025.100449)
  • [L3] Due to its demonstration of sufficient biomechanical properties, fascia lata allograft seems an appropriate treatment option for ligamentous reconstruction of chronic elbow instability. [25] (10.1016/j.jseint.2024.05.002)
  • [Case_report] The dual IJS system provided an innovative framework for managing severe elbow instability patterns while ensuring greater joint stability. [28] (10.1016/j.xrrt.2026.100684)
  • [L3] Atraumatic posterolateral rotatory instability should be considered in the differential diagnosis of lateral elbow when patients present with a protracted clinical course. [29] (10.1016/j.jseint.2021.02.008)
  • [L5] Posterolateral rotatory instability of the elbow is a clinical syndrome caused by insufficiency of the lateral ulnar collateral ligament, presenting with clicking, locking, or recurrent dislocation. [30] (10.5435/00124635-200411000-00005)
  • [L4] Use of an IJS allows for early, congruent, and stable ulnohumeral and radiocapitellar range of motion in instances of persistent elbow instability. [31] (10.1016/j.jhsa.2018.05.031)
  • [L4] When augmenting surgical fixation for elbow instability, the IJS may be preferable for patients with complex comorbidities or social dynamics. [32] (10.1016/j.jse.2022.04.002)
  • [L3] [34] (10.1016/j.jse.2025.09.010)
  • [L1] At time zero, UCLR has inferior biomechanical properties compared with the native intact ligament. [38] (10.1177/23259671251407657)
  • [Paper] This technique allows accurate graft placement and fixation with maximal protection of the active elbow stabilizers like the common extensor tendons and the anconeus muscle. [39] (10.1016/j.eats.2019.10.013)
  • [Paper] When precise surgical steps are followed, this technique can be performed in a reliable, efficient, and reproducible manner for patients with posterolateral rotatory instability of the elbow. [40] (10.1016/j.eats.2017.03.029)
  • [L4] Females demonstrated favorable clinical outcomes at a mean follow-up of 6 years, with a majority of elbows returning to a preinjury level of function and sport, regardless of whether they underwent primary or revision surgery. [41] (10.1016/j.jse.2025.08.025)
  • [L4] [42] (10.1016/j.injury.2012.04.023)
  • [L5] [43] (10.1016/j.jisako.2024.03.003)
  • [L4] [44] (10.1016/j.xrrt.2024.03.008)
  • [L4] [45] (10.1016/j.jisako.2025.101059)
  • [Paper] [46] (10.1016/j.eats.2020.10.008)
  • [L1] [47] (10.1177/0363546520921160)
  • [L4] Clinically, augmented UCL repair demonstrated excellent return to previous level of play and Kerlan Jobe Orthopaedic Clinic scores with modest complications and time to return. [49] (10.1016/j.arthro.2023.09.030)
  • [L3] Those who experience medial elbow pain are at increased risk for further surgical intervention. [51] (10.1177/2325967118808782)
  • [L3] However, its use is weighed against a 17% rate of removal at early follow up and possibly inferior forearm rotation. [52] (10.1177/17585732221088290)
  • [L4] Graft site morbidity occurred in 1% of the patients after an ulnar or lateral collateral ligament reconstruction procedure. [53] (10.1177/0363546517693836)
  • [L4] Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving <50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation. [55] (10.5397/cise.2018.21.4.234)
  • [L4] The revision rate for UCLR with allograft appears to be greater compared to UCLR with autograft, although this may be secondary to limited allograft literature. [58] (10.1016/j.jse.2023.10.023)
  • [L2] A review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. [59] (10.1177/0363546518765139)
  • [L4] Primary LUCL reconstruction for PLRI offers a reliable return to pre-injury level of function among active individuals with intense upper extremity demands, though there is a >15% rate of perioperative complications. [61] (10.1016/j.arthro.2017.04.077)
  • [L4] The literature demonstrates a distinct difference in complication profile between external fixation and the IJS when used as treatment for traumatic elbow instability. [62] (10.1016/j.xrrt.2023.12.004)

See Also

References

[1] Isolated displaced type II partial articular radial head fracture: correlation of preoperative imaging with intraoperative findings of lateral ulnar collateral ligament tear. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.07.006

[2] Elbow range of motion is stable or improves following ulnar collateral ligament repairs and reconstructions. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.10.002

[3] A clinical review of elbow ligament repairs and reconstructions in the acute and chronic settings. JSES International. 2024. DOI: 10.1016/j.jseint.2024.02.013

[4] Comparing Static Stability of Native Elbow With Static Stability of Novel Bidirectional Ligament Reconstruction at Different Degrees of Elbow Flexion. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.02.003

[5] Stabilization of Recurrent Elbow Instability in a Patient with Ehlers-Danlos Syndrome. JBJS Case Connector. 2019. DOI: 10.2106/jbjs.cc.19.00355

[6] Elbow flexion angle during graft fixation for ulnar collateral ligament reconstruction: a systematic review of outcomes and complications. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.07.029

[7] Lateral elbow ligament reconstruction for posterolateral rotatory instability: 10 years follow-up in 32 patients. JSES International. 2023. DOI: 10.1016/j.jseint.2022.12.009

[8] Static stability of novel uncemented elbow hemiarthroplasty stabilized with ligament reconstruction. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.07.037

[9] Injury chronicity does not affect outcomes following ligament repair with suture tape augmentation for post-traumatic elbow instability. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.11.011

[10] Does an Internal Joint Stabilizer and Standardized Protocol Prevent Recurrent Instability in Complex Persistent Elbow Instability?. Clinical Orthopaedics & Related Research. 2022. DOI: 10.1097/corr.0000000000002159

[11] Lateral Ulnar Collateral Ligament Repair With Suture-Tape Augmentation for Traumatic Elbow Instability. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.10.016

[12] Repair and augmentation of the lateral collateral ligament complex using internal bracing in dislocations and fracture dislocations of the elbow restores stability and allows early rehabilitation. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05402-9

[13] Postoperative Elbow Instability: Options for Revision Stabilization. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.10.015

[14] Using External Joint Stabilizer – Elbow (EJS-E) for treating elbow instability—biomechanical assessment and clinical outcomes. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-06103-0

[15] Arthroscopic Repair of the Lateral Ulnar Collateral Ligament of the Elbow Using a Knotless Suture Anchor. Arthroscopy Techniques. 2018. DOI: 10.1016/j.eats.2017.08.057

[17] Indications, Outcomes, and Complications of Lateral Ulnar Collateral Ligament Reconstruction of the Elbow for Chronic Posterolateral Rotatory Instability: A Systematic Review. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520927412

[18] Internal joint stabilizer vs. stand-alone ligament repair in treatment of traumatic elbow instability: an age-matched analysis. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.03.012

[19] Testing of a Novel Method for Securing Ligaments Against Bone During Simultaneous Medial and Lateral Elbow Ligament Reconstruction. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.02.008

[20] Elbow Ulnar Collateral Ligament Shoelace Repair with Internal Bracing for Treating Throwing Athletes Who Have Ulnar Collateral Ligament Instability. Arthroscopy Techniques. 2021. DOI: 10.1016/j.eats.2021.04.008

[21] Posterolateral stabilization of the elbow by autologous ligament reconstruction to limit long-term development of osteoarthritis. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.01.011

[22] The internal joint stabilizer for chronic elbow dislocation: a surgical technique. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.02.001

[23] Three-dimensional computed tomography modeling for kinematic analysis of double-strand lateral ulnar collateral ligament reconstruction. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.11.070

[24] Pragmatic Comparative Study of Radial Head Replacement Without Lateral Ulnar Collateral Ligament Tear Versus Augmentation with Internal Brace Technique. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100449

[25] Fascia lata allograft: a suitable alternative in ligamentous reconstruction for chronic elbow instability?. JSES International. 2024. DOI: 10.1016/j.jseint.2024.05.002

[28] Dual internal joint stabilizer placement for elbow instability: a case report. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100684

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