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Lateral Collateral Reconstruction With Free Tendon Graft
Acute elbow dislocation involves various degrees of capsular ligament detachment. In most cases, the capsular ligaments are avulsed from the humeral attachment, which typically starts from the lateral aspect of the elbow and propagates medially. Therefore, the lateral collateral ligament (LCL) is almost always disrupted in acute elbow dislocation, but disruption of the MCL varies depending on the injury severity. In the absence of an associated fracture, such as a simple elbow dislocation, closed reduction followed by a short period of immobilization usually is sufficient to achieve a stable elbow joint with no substantial sequelae. In patients with such injury, the capsular ligaments typically are avulsed from their humeral attachments and heal, provided the elbow is protected from further stresses. In the presence of concomitant fracture, such as complex elbow dislocation, surgery typically is required to address the fractures and ligamentous disruptions after initial closed reduction of the dislocation. Recurrent subluxation of the elbow joint, that is, posterolateral rotatory instability (PLRI), is uncommon. PLRI typically results not from insufficiency of the LCL complex in general, but from insufficiency of the LCL in particular. PLRI after elbow dislocation most commonly occurs in adolescence. Other conditions associated with PLRI include iatrogenic injury to the LCL during débridement to manage lateral epicondylitis; connective tissue disorders such as Ehlers-Danlos syndrome; and long-standing cubitus varus deformity, such as malunion of a supracondylar fracture sustained in childhood. Additionally, PLRI can be a sequela of steroid injection to manage lateral epicondylitis. This chapter reviews the surgical indications, contraindications, and outcomes of studies on repair and reconstruction of the LCL using various grafts and fixation techniques. Surgical strategies and tips for avoiding complications and pitfalls are also discussed.