Seo Joong-Bae, Yi Hyung-Suk, Kim Kyu-Beom, Yoo Jae-Sung
Department of Orthopaedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea.
J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(1):2309499020908348. doi: 10.1177/2309499020908348.
The pathoanatomy and biomechanics of elbow instability have been previously reported; however, few researchers have dealt with the operative management and clinical consequence of recurrent elbow instability. Recent studies on arthroscopic lateral collateral ligament (LCL) complex repair have reported successful outcomes similar to those achieved by open repair. We aimed to determine the validity of arthroscopic repair of the LCL complex in elbows with unstable dislocation with or without intra-articular fracture.
Eighteen consecutive patients who had undergone arthroscopic repair of the LCL complex for unstable dislocation of the elbow with or without intra-articular fracture and who were followed for at least 12 months were included in the study. Ligament injury combined with coronoid and/or radial head fractures were treated with arthroscopic technique. Pain, range of motion, clinical outcomes based on the Mayo Elbow Performance Score (MEPS), and surgical complications were evaluated.
At 12 months follow-up, all 18 patients demonstrated complete settlement of the instability and mean (and standard deviation) extension of 1.7 ± 3.8°, flexion of 138.3 ± 3.8°, supination of 88.6 ± 5.3°, and pronation of 88.2 ± 5.6°. The average MEPS was 97.7 ± 3.9 points and according to this validated outcome score. However, slight widening (2 mm) of the radiocapitellar joint space was accompanied in one patient, although the varus stress test and pivot shift test were not observed. One patient showed delayed union of the anteromedial facet fracture, and two patients showed pin site irritation, which was a complication of arthroscopic coronoid fracture fixation and was fully resolved after pin removal.
In patients with unstable elbow dislocation, with or without an intra-articular fracture, arthroscopic repair of the LCL complex is an effective and alternative treatment option that can restore elbow stability and have satisfactory clinical and radiographic results.
先前已有关于肘关节不稳定的病理解剖学和生物力学的报道；然而，很少有研究人员涉及复发性肘关节不稳定的手术治疗及临床后果。最近有关关节镜下外侧副韧带（LCL）复合体修复的研究报告称，其成功结果与开放修复相似。我们旨在确定关节镜下修复LCL复合体在伴有或不伴有关节内骨折的不稳定肘关节脱位中的有效性。
本研究纳入了连续18例因肘关节不稳定脱位伴或不伴关节内骨折而接受LCL复合体关节镜修复且随访至少12个月的患者。韧带损伤合并冠状突和/或桡骨头骨折采用关节镜技术治疗。评估疼痛、活动范围、基于梅奥肘关节功能评分（MEPS）的临床结果以及手术并发症。
在12个月的随访中，所有18例患者的不稳定均完全得到解决，平均（及标准差）伸展为1.7±3.8°，屈曲为138.3±3.8°，旋后为88.6±5.3°，旋前为88.2±5.6°。根据这一经过验证的结果评分，平均MEPS为97.7±3.9分。然而，1例患者伴有桡骨头关节间隙轻度增宽（2mm），尽管未观察到内翻应力试验和轴移试验异常。1例患者出现前内侧小关节面骨折延迟愈合，2例患者出现针道刺激，这是关节镜下冠状突骨折固定的并发症，拔除钢针后完全缓解。
对于伴有或不伴有关节内骨折的不稳定肘关节脱位患者，关节镜下修复LCL复合体是一种有效的替代治疗选择，可恢复肘关节稳定性，并获得满意的临床和影像学结果。
