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Evaluation and Management of Posterolateral Rotatory Instability (PLRI)

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Book cover The Unstable Elbow

Abstract

Posterolateral rotatory instability (PLRI) describes a pattern of ligamentous instability in which the proximal ulna and radial head externally rotate about the distal humerus when the forearm is positioned in supination and slight flexion. Insufficiency of both the static ligamentous stabilizers and the dynamic stabilizers of the posterolateral elbow is accepted as the cause with the lateral ulnar collateral ligament (LUCL) as the main static stabilizing component. This ligament originates at the lateral epicondyle and inserts onto the supinator crest. PLRI is generally considered in a continuum of stages ranging from minor laxity to recurrent elbow dislocations. Initial treatment is conservative. If the instability symptoms persist after adequate conservative treatment, surgical treatment can be considered. Invasive treatment varies from direct repair to the reconstruction of the lateral ligamentous complex. This chapter discusses the background, history and treatment of PLRI focusing on the diagnostic and surgical techniques.

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Author information

Authors and Affiliations

  1. Department of Orthopedic, AZ Monica, Deurne, Stevenslei 20, Deurne, Antwerpen, 2100, Belgium

    Pieter Caekebeke MD

  2. Department of Orthopedics, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA

    Megan Anne Conti Mica MD

  3. Department of Orthopedic Surgery and Traumatology, AZ Monica, Stevenslei 20, Deurne, Antwerpen, 2100, Belgium

    Roger van Riet MD, PhD

Authors
  1. Pieter Caekebeke MD
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  2. Megan Anne Conti Mica MD
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  3. Roger van Riet MD, PhD
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Corresponding author

Correspondence to Roger van Riet MD, PhD .

Editor information

Editors and Affiliations

  1. Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, Utah, USA

    Robert Z. Tashjian

Electronic Supplementary Material

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Bone bridge at the proximal epicondyle. The free ends of the graft are prepared with a braided synthetic Krackow suture. The humeral tunnel is then prepared and two drill holes connected to the tunnel for suture and graft passage. With sutures passed through the humeral drill holes, the two ends of the graft are pulled into the humeral tunnel. It is important to make sure that the graft is of appropriate length so that the free limbs do not both bottom out in the humeral tunnel (MP4 653,201 kb)

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Caekebeke, P., Mica, M.A.C., van Riet, R. (2017). Evaluation and Management of Posterolateral Rotatory Instability (PLRI). In: Tashjian, R. (eds) The Unstable Elbow. Springer, Cham. https://doi.org/10.1007/978-3-319-46019-2_10

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  • DOI: https://doi.org/10.1007/978-3-319-46019-2_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-46017-8

  • Online ISBN: 978-3-319-46019-2

  • eBook Packages: MedicineMedicine (R0)

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