Elbow instability is a problem that can be experienced by some patients after suffering an injury to the lateral (outside) or medial (inside) areas of the elbow. The majority of these injuries are the result of an elbow dislocation or overuse (i.e. medial ulnar collateral ligament failure in throwers). Many times, these problems can be managed through a combination of activity modification and rehabilitation. However, this does not work with all patients as life, careers, and sporting activities can be impacted by this disorder. In those cases, there are surgical procedures that can be performed to help patients return to their prior levels of activities with a stable elbow. These procedures are open procedures that consist of either a ligament repair or reconstruction depending on the status of the injured structures.
Candidates for Elbow Instability Surgery
After a diagnosis is made via physical examination, patients who are candidates for these surgeries will have an MRI (most cases) or CT scan (select cases) to confirm the diagnosis. Patients who are candidates may have the following conditions:
- Elbow Dislocation
- Posterolateral Rotatory Instability
- Medial Ulnar Collateral Ligament Insufficiency
The Instability Procedure
The repair or reconstruction procedure is performed while the patient is sedated under general anesthesia, and is usually performed on an outpatient basis. In some cases, the patient will receive a nerve block before surgery that will help with pain control and keep the arm numb for 18-24 hours.
For patients who undergo repair, the procedure consists of an incision on the outside or inside of the elbow depending on what ligaments are injured. The ligaments are repaired back to their correct anatomic location under the correct tension using heavy suture and anchors that are placed in the bone.
For patients who undergo reconstruction, the procedure consists of an incision on the outside or inside of the elbow depending on what ligaments are injured. The anatomic origin and insertion of the normal ligament are marked and the ligament is reconstructed. This is done with an autograft (using your own tissue) or allograft (using tissue from a cadaver) to reconstruct the ligament(s) in the correct location and under the correct tension.
The incision is closed with sutures that do not need to be removed and a splint is placed.
Recovery from Ligament Repair or Reconstruction
After surgery, most patients go home the same day with a splint in place. The splint will remain on until the first follow up visit at which point the patient is placed in a hinged brace that gradually allows more motion as the ligament heals. The first 6-12 weeks are a critical time point to allow the ligament repair or reconstruction to heal. Patients typically undergo a course of physical therapy and throwers may begin a gradual throwing program at 4 months post-operatively. Most throwers typically return to full competition 10-12 months after surgery.
Risks of Elbow Instability Surgery
While elbow ligament repair or reconstruction are considered safe procedures, there are some risks to these procedures:
- Nerve or Vessel Injury
- Failure of the Repair or Reconstruction
- Blood Clots
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