Abstract
This chapter presents the technique and the results of arthroscopic plication of the radial component of the lateral collateral ligament (R-LCL). Elongation or partial articular-sided tears of the R-LCL may lead to a symptomatic minor instability of the lateral elbow (SMILE) and cause lateral elbow pain and disability. An all-arthroscopic technique to repair the R-LCL with a suture anchor was developed. The benefits of this all-arthroscopic procedure for surgical stabilization of the R-LCL include smaller incisions with less soft-tissue dissection, better visualization of the joint, easier accessibility for surgical instruments, and possibility of effective control lateral elbow patholaxity. The main steps of the operation are test of lateral elbow patholaxity, evaluation of the annular drive-through (ADT) sign, inspection of the radial side of the joint, insertion of a suture anchor through the anterolateral portal, shuttling of the suture anchor through the ligament, and verification of effective elimination of the annular drive-through sign. This technique of R-LCL plication ensures an anatomic repair.
We analyzed the presence of intra-articular pathologic findings in 35 patients, and we treated with R-LCL plication 27 patients, which were subsequently evaluated at a median follow-up of 2.1 years. In this group, mean single assessment numeric evaluation (SANE) improved from median of 30 points preoperatively to 90 at final follow-up, and 96.3% patients obtained good or excellent subjective results. No major complications were observed.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Arrigoni P, Cucchi D, D’Ambrosi R, Butt U, Safran MR, Denard P, Randelli P. Intra-articular findings in symptomatic minor instability of the lateral elbow (SMILE). Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2255–63. https://doi.org/10.1007/s00167-017-4530-x.
Arrigoni P, Cucchi D, Menon A, Randelli P. It’s time to change perspective! New diagnostic tools for lateral elbow pain. Musculoskelet Surg. 2017;101(S2):175–9.
Bryce CD, Armstrong AD. Anatomy and biomechanics of the elbow. Orthop Clin North Am. 2008;39(2):141–54, v. https://doi.org/10.1016/j.ocl.2007.12.001.
Adams JE, King GJ, Steinmann SP, Cohen MS. Elbow arthroscopy: indications, techniques, outcomes, and complications. Instr Course Lect. 2015;64:215–24.
Arrigoni P, Cucchi D, Guerra E, Marinelli A, Menon A, Randelli P, Pederzini L. Distance of the posterior interosseous nerve from the radial head during elbow. Arthroscopy: an anatomical study. Joints. 2017;05(3):147–51.
Arrigoni P, Cucchi D, Menon A, Guerra E, Nicoletti S, Colozza A, Luceri F, Pederzini LA, Randelli PS. The posterior interosseous nerve crosses the radial head midline and increases its distance from bony structures with supination of the forearm. J Shoulder Elbow Surg. 2019;28(2):365–70.
Arrigoni P, D’Ambrosi R, Randelli P. Arthroscopic treatment of annular drive through and radial lateral collateral ligament articular-side tear of the elbow. Arthrosc Tech. 2015;4(6):e647–50. https://doi.org/10.1016/j.eats.2015.07.001.
Arrigoni P, D’Ambrosi R, Guerra E, Randelli P. Anatomy at risk, portals, and relevant attentions to reduce the risk of nerve injury of the elbow. In: Arthroscopy – basic to advanced. Berlin: Springer Berlin Heidelberg; 2016. p. 683–9. https://doi.org/10.1007/978-3-662-49376-2_54.
Arrigoni P, Cucchi D, Guerra E, Luceri F, Nicoletti S, Menon A, Randelli P. No neurovascular damage after creation of an accessory anteromedial portal for arthroscopic reduction and fixation of coronoid fractures. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):314–8.
Acknowledgment
Conflict of Interest: None
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 ISAKOS
About this chapter
Cite this chapter
Arrigoni, P.A., D’Ambrosi, R., Cucchi, D., Randelli, P.S. (2020). Arthroscopic Plication of the Radial Component of the Lateral Collateral Ligament (R-LCL). In: Bain, G., Eygendaal, D., van Riet, R. (eds) Surgical Techniques for Trauma and Sports Related Injuries of the Elbow. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58931-1_37
Download citation
DOI: https://doi.org/10.1007/978-3-662-58931-1_37
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-58930-4
Online ISBN: 978-3-662-58931-1
eBook Packages: MedicineMedicine (R0)