Surgical management of lateral ulnar collateral ligament injuries in elbow dislocations and fracture-dislocations: Comparative outcomes of primary repair and palmaris longus tendon reconstruction.

Abstract

ObjectivesThis study compared outcomes of primary repair and palmaris longus tendon reconstruction in patients with lateral ulnar collateral ligament (LUCL) injuries.Material and MethodA retrospective comparative cohort study was conducted between 2017 and 2023, including 40 patients who underwent surgery for elbow dislocation or fracture-dislocation with intraoperatively confirmed LUCL injury. Surgical choice was made intraoperatively: repair was performed if the ligament could be reattached without tension, while reconstruction was selected if the tissue was shortened, retracted, or degenerative. Patients were divided into a repair group (n = 17) and a reconstruction group (n = 23). Clinical outcomes included Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Mayo Elbow Performance Score (MEPS), range of motion (ROM), fracture healing, and complications, with a mean follow-up of 26.4 months.ResultsThe repair group showed mean VAS 16.2, QuickDASH 9.7, MEPS 89.9, and ROM 137.2°, while the reconstruction group had VAS 17.2, QuickDASH 8.4, MEPS 89.0, and ROM 133.6°. There were no significant differences in VAS, QuickDASH, or MEPS, though the repair group demonstrated superior ROM (p = 0.029). The absolute ROM difference (∼3-4°) was not considered clinically meaningful. In isolated LUCL cases (n = 15), no significant differences were observed between groups. All associated fractures achieved union without non-union or malunion. Complications included heterotopic ossification in seven patients (three repairs, four reconstructions) and two superficial infections, all successfully managed without reoperation. No patient developed recurrent instability, nerve deficits, or clinically significant stiffness.ConclusionBoth primary repair and palmaris longus tendon reconstruction provided satisfactory outcomes and durable stability. Although the repair group showed slightly greater ROM, this difference was not clinically relevant and disappeared when patients with concomitant fractures were excluded. Injury complexity, rather than surgical technique, appears to be the main determinant of long-term function.