Effective combination of arthroscopic and minimally invasive surgery for chronic posterolateral elbow instability

Introduction Trauma and extreme physical activity may result in common patterns of forearm dislocation, which account for 10 to 25 % of all elbow injuries in the adult population. Good long-term results of eliminating joint dislocation with the use of conservative treatment have been much described, but 8 % of patients experience symptoms of chronic instability. We present a case of successful arthroscopic treatment of ligamentous stabilizers of the elbow joint using an effective combination of implants for its posterolateral instability. We found no publications on such an experience in the Russian literature.

The purpose of the work is to present a clinical case of an effective combination of arthroscopic and minimally invasive surgery methods for reconstruction of the ligamentous apparatus in chronic posterolateral instability of the elbow joint.

Material and methods Patient N., 31 years old, suffered chronic posterolateral rotational instability of the left elbow joint after dislocation of the forearm bones for more than 10 years. The operative technique was based on the principles of minimally invasive reconstructive plastic surgery and meets the objectives of  gentle treatment of soft tissues, allowing visualization of the lesion and avoiding the contact with neuro‑vascular structures. Baseline clinical tests (O'Driscoll, Regan/Lapner, Pollock), questionnaires (VAS, DASH, MEPS, SF‑36), and MRI, 1.5 Tesla MRI scans of dynamic stabilizer disruption are reflected. Evaluation was performed at two control points (45 and 180 days).

Results The assessment was carried out at two control points. First follow-up (45 days): flexion/extension 50/175º, pronation/supination 90/90º, VAS 2, DASH 24.2, MEPS 80 points, respectively. Second follow‑up (180  days): VAS 1, DASH 9.2, MEPS 95 points, comparative ranges of motion corresponded to  a  healthy joint. An  MRI study confirmed the progress of the autotenograft and tendon ligamentization in  the  area of reinsertion, the absence of inflammatory changes and no heterotopic ossification.

Discussion Improvements in elbow surgery and technical progress are focused on minimally invasive interventions, while arthroscopy of the elbow joint is still technically difficult due to a limited space. And yet, this is an effective treatment method, as a result of which specialists can avoid a wide range of complications (14.7 %), and patients start rehabilitation faster and, as a result, recover faster than with open surgical approaches with a higher percentage of risks (52 %).

Conclusion The combination of the above techniques avoids conflict with neurovascular structures, provides visual control of the implantation of anchors and, as a result, reduces the overall risk of complications in the treatment of a rare group of patients with instability of the elbow joint.

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