Operative Management of Posterolateral Rotatory Instability in Females: Favorable 6-Year Outcomes in Primary and Revision Elbows.

Abstract

Posterolateral rotatory instability (PLRI) is an instability pattern due to injury of the radial ulnohumeral ligament (RUHL) or lateral ulnar collateral ligament complex of the elbow. Recent literature has demonstrated that females may be more predisposed to this condition due to elevated levels of estrogen and progesterone. The purpose of this study was to analyze patient-reported outcome measures and return to pre-injury level of function for females who underwent operative management for PLRI. All females who underwent surgical management of the elbow at a single academic institution between 2011 and 2021 were retrospectively reviewed. Patients were included if they underwent arthroscopic or open repair/reconstruction of their RUHL. At final postoperative follow-up, patient-reported outcome measures including Single Assessment Numeric Evaluation (SANE) and Mayo Elbow Performance Score (MEPS) were obtained. Patients were asked if their elbow had returned to pre-injury level of function and athletes were asked if they returned to sport postoperatively. Subsequent complications and surgeries were also recorded. A total of 37 patients (41 elbows) were analyzed with 90.2% (37/41) having undergone RUHL repair while 9.8% (4/41) underwent reconstruction. Sixty-one percent (25/41) had acute symptoms affecting their dominant elbow. Thirty-four percent (14/27) of patients underwent prior surgery to their affected elbow. At a mean follow-up of 6.1 ± 2.7 years, the mean SANE and MEPS of the entire cohort at final follow-up was 95.9 ± 8.5 and 86.3 ± 14.3, respectively. Based on the MEPS, 32 elbows had excellent or good outcomes while 9 had fair or poor outcomes. Eighty-three percent (34/41) of patients stated their elbow returned to pre-injury level of function while 92.9% (13/14) of athletes were able to return to sport postoperatively. There was no significant difference in outcomes between those that were treated arthroscopically versus an open approach (p ≥ 0.331), acutely versus chronically (p ≥ 0.538), and those who underwent primary versus revision surgery (p ≥ 0.061). Females demonstrated favorable clinical outcomes at a mean follow-up of 6 years with a majority of elbows returning to pre-injury level of function and sport, regardless of whether they underwent primary or revision surgery. Additionally, there was no significant difference in outcomes for elbows treated arthroscopically or through an open approach. These findings support the efficacy of RUHL repair in females with PLRI and suggest favorable outcomes can be achieved even in revision settings.