The Circumferential Graft Technique for Treatment of Chronic Multidirectional Ligamentous Elbow Instability.

Hackl, Michael; Müller, Lars Peter; Wegmann, Kilian · JBJS Essent Surg Tech · 2017

expert_opinion · Level V

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Abstract

The circumferential graft technique<sup>1,2</sup> represents a potential option for the treatment of multidirectional ligamentous elbow instability using a single tendon graft (Video 1). Approach the elbow joint through either a single posterior skin incision or separate lateral and medial incisions. Create humeral and ulnar bone tunnels for circumferential graft placement. Use a plantaris allograft, which we recommend; however, a semitendinosus autograft may also be used. Ensure that meticulous wound closure is achieved as it is key to preventing postoperative complications such as superficial or deep infection and persistent seroma. As multidirectional instability represents a rather rare complication following ligamentous elbow dislocation, clinical data regarding the circumferential graft technique are scarce<sup>1,2</sup>.

Anatomy