Early Results of a Novel Method to Treat Bidirectional Elbow Instability: A Pilot Study.

Purpose: To describe a novel reconstructive technique for bidirectional elbow instability using a cylindrical ligament retention device in the distal humerus and toothed metal plates for graft fixation to the proximal ulna and to report early outcomes in the first four patients treated with this technique. Methods: Patients who underwent this procedure exhibited either preoperative or anticipated intraoperative bidirectional elbow instability. Preoperative, postoperative, and intraoperative examination findings were obtained. Results: All patients were stabilized with this bilateral ligament reconstruction. Three patients required an interposition arthroplasty. One patient, who underwent interposition arthroplasty, required use of his operated arm for transfers, which necessitated an external fixator that was removed at 6 weeks. Despite subsequent splinting, he developed lateral widening on examination at 12 weeks after surgery and underwent a revision, which became infected requiring the removal of both the ligament reconstruction and interposition arthroplasty. The mean preoperative Quick Disabilities of the Arm, Shoulder, and Hand score was 73.3and Mayo Elbow Performance Score was 26.3. After surgery, in the three patients who remained stable, the mean Quick Disabilities of the Arm, Shoulder, and Hand score improved to 51 at 3 months and the mean Mayo Elbow Performance Score improved to 85 at 3 months. Conclusions: Three patients have remained stable at their elbow status post bilateral ligament reconstruction. One patient developed elbow subluxation and had a second procedure performed, which led to an infection and removal of all hardware. A contraindication to this procedure may be need for early force application to the elbow in the postoperative period. Future patients will clarify the clinical utility of this bilateral ligament reconstruction. Type of study/level of evidence: Therapeutic IV.