Box-loop ligament reconstruction of the elbow for medial and lateral instability.

Abstract

Elbow instability remains a challenging surgical problem. Most commonly, isolated reconstructions of the medial collateral ligament or lateral collateral ligament are performed; however, on occasion, there can be deficiency that requires reconstruction of both ligaments. The senior author has developed a method to reconstruct both the medial and lateral collateral ligaments using 1 graft. This technique uses a "box-loop" design, whereby the donor tendon is passed through the humerus and ulna and tied back to itself, creating a loop. Fourteen cases with mean follow-up of 64 months were reviewed. Nine patients returned to the clinic and were evaluated both clinically and radiographically. An additional 5 patients participated by phone questionnaire. Average follow-up time was 64 months (range, 19-109 months). According to the Summary Outcome Determination given by the patients, 7 elbows were normal or nearly normal, 4 were greatly improved, 2 were improved, and 1 was worse compared with before surgery. The Summary Outcome Determination score average was 7 (range, -2 to 10). American Shoulder and Elbow Surgeons scores (including both clinic patients and phone questionnaire patients) ranged from 36 to 100, with an average of 81; of 14 patients, 8 had an American Shoulder and Elbow Surgeons self-satisfaction score of 10. The average Quick Disabilities of the Arm, Shoulder, and Hand score was 13 (range, 0-64). The average Mayo Elbow Performance Index score was 88 (range, 60-100), with 4 excellent (90-100), 3 good (75-89), and 3 fair (60-74) results and no poor results. This technique was found to have excellent midterm results. Compared with separate medial- and lateral-sided reconstruction, there is simplification of bone tunnel formation as well as graft fixation.