Transposition of the local extensor fascia for elbow lateral collateral ligament reconstruction: Results in a group of competitive athletes.

Abstract

The lateral ulnar collateral ligament (LUCL) is a primary elbow stabilizer against posterolateral rotatory instability (PLRI). Direct repair is the treatment of choice in the acute setting, whereas reconstruction is the best option in patients with chronic PLRI. Several autograft/allograft solutions can be used to perform LUCL reconstruction, including a local extensor fascia septum autograft. In this retrospective multicenter study, 38 patients (26 males and 12 females) with chronic PLRI of the elbow underwent LUCL reconstruction with a local extensor fascia septum autograft. Patients' mean age at the time of surgery was 35.5 ± 9.6 years. The right elbow was involved in 29 cases and the left elbow in 9 cases. The dominant arm was involved in 23 (61%) patients. All patients were competitive athletes practicing different sports. Clinical assessments included range of motion and stability using the Mayo Elbow Performance Score (MEPS), the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, the visual analog scale (VAS), and the rate of return to sports. Radiographs were taken to evaluate joint congruency, heterotopic ossifications, and grade of osteoarthritis. At a mean follow-up of 36.7 ± 7.8 months, the range of motion in flexion and extension was comparable to preoperative values, whereas the postoperative MEPS, the QuickDASH score, and the VAS score showed statistically significant differences (p < 0.001). Before the procedure, the MEPS was 76 ± 12.6, the QuickDASH score was 23 ± 5.6, and the VAS score during the activities was 5 ± 3. At the last follow-up, the MEPS was 97 ± 5.9 and the QuickDASH score was 1.3 ± 2.8; both showed a statistically significant improvement (p < 0.001). The VAS score was 0.34 ± 0.67 and was also statistically significantly improved (p < 0.001). The significant improvement in the functional scores enabled 33 of the 38 patients to return to their previous sports level. The high rate of return to previous sports level of our cohort of athletes demonstrates that the local extensor fascia septum autograft is a viable LUCL reconstruction option for patients with chronic PLRI. Further prospective studies are needed to validate these encouraging results. Level IV, Case Series, Prognosis Studies.