Surgical management of posterolateral rotatory instability of the elbow with associated posterior capitellar lesions: a retrospective case series.

purposeElbow dislocations are associated with complex ligamentous and osseous injuries, leading to a spectrum of instability patterns, most notably posterolateral rotatory instability (PLRI). Among these, bony defects of the posterior capitellum are commonly observed in patients following elbow dislocation or presenting with persistent instability. The clinical relevance of these lesions and the optimal management strategy remain subject of ongoing debate. This study aimed to assess the outcomes of surgically treated PLRI in the presence of posterior capitellar lesions, with the hypothesis that isolated ligament repair is sufficient to restore joint stability and function.

methodsPatients with PLRI and posterior capitellar bone defects who underwent surgical treatment between 2013 and 2022 were retrospectively reviewed. Defect size was evaluated using CT and MRI scans. Clinical outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score, Mayo Elbow Performance Score (MEPS), and a subjective Elbow Score. Persistent instability was evaluated using the Chair push-up test.

resultsEleven patients (mean age: 39.8 years; range: 18-50) met the inclusion criteria. The mean follow-up was 46 months (range: 19-120). All patients had sustained traumatic elbow injuries, with eight reporting a single dislocation event and three experiencing recurrent instability. Seven patients were treated arthroscopically, while four patients underwent open surgical procedures. Ligamentous injuries were treated with either repair or reconstruction (± bracing). At the final follow-up, the mean MEPS was 95 (range: 70-100), and the mean QDASH score was 4.6 (range: 0-22.73). A positive Chair push-up test was observed in three cases. The mean subjective Elbow Score was 92.5 (range: 70-100).

conclusionIn this case series, ligament-based surgical treatment of PLRI with associated posterior capitellar lesions was associated with generally favorable patient-reported outcomes. These findings highlight the need for larger, standardized studies to clarify the clinical relevance and treatment thresholds of posterior capitellar lesions. Standardized protocols are needed for defect size assessment and evidence-based guidelines for managing posterior capitellar lesions remain necessary to optimize care.