Technique Spotlight: Reconstruction of the Lateral Ulnar Collateral Ligament

Indications

The most common indication for lateral ulnar collateral ligament (LUCL) reconstruction is a chronic posttraumatic posterolateral rotatory instability of the elbow resulting in mechanical symptoms, pain, and disability. While prior trauma is the most common etiology of LUCL insufficiency, other causes of chronic LUCL instability include the following:

• Severe lateral epicondylitis, particularly if several corticosteroid injections were used for treatment, or an aggressive surgical debridement has been performed.

• After lateral elbow or distal humeral surgery for other reasons apart from epicondylitis resulting in iatrogenic injury.

• Cubitus varus deformity resulting in tardy posterolateral rotatory instability.

Preoperative Evaluation

The diagnosis of this pathology is based on history and clinical examination. Patients will typically present with complaints of lateral elbow pain and clicking or locking of the elbow. On examination, a posterior drawer test is typically painful and shows posterior displacement of the radial head with respect to the capitellum. Pivot-shift testing is also positive in these patients.

Imaging is typically not very useful for confirming the posterolateral rotatory instability of the elbow, unless acute rupture or avulsion lesions can be seen. It is important to remember that chronic insufficiency of the LUCL is a dynamic condition. In some cases, the lateral ligaments may appear present and intact on advanced imaging but are clinically incompetent.

If a posterolateral rotatory instability of the elbow is highly suspected but clinical examination is not clear enough or difficult to perform due to pain or poor patient collaboration, an exploration under anesthesia is recommended. Sometimes, an elbow arthroscopy is necessary to reveal the subluxation of the articular surfaces under direct vision.