Original Article With Video Illustration| Volume 30, ISSUE 6, P679-687, June 2014

A Preliminary Report of Acute and Subacute Arthroscopic Repair of the Radial Ulnohumeral Ligament After Elbow Dislocation in the High-Demand Patient


      The purpose of this study was to evaluate functional outcomes, range of motion (ROM), elbow stability, and time to return to full activities after acute and subacute arthroscopic repair of a simple elbow dislocation in high-demand patients.


      “High-demand patients” were defined as in-season athletes and individuals who required use of both hands for their profession and believed that they could not miss the 6 weeks of work that may be required with conservative treatment in an elbow brace. We retrospectively reviewed 14 consecutive patients with a simple elbow dislocation who underwent arthroscopic repair of the radial ulnohumeral ligament from 2008-2012. Outcomes measures included the Mayo Elbow Performance Score (MEPS), elbow ROM, elbow stability, and time to return to full activities. Each patient was contacted once by telephone to determine the current activity level and presence of any pain or functional limitations.


      The mean patient age was 25 years, with telephone follow-up at a mean of 30 months and clinical examination after a minimum of 6 months. The postoperative MEPS was excellent (mean, 99.6; range, 95 to 100) for all 14 patients, and all returned to their preinjury level of function with no restrictions or instability. Final ROM averaged −3° of full extension to greater than 130° of flexion. The mean time to return to full activities in and out of a brace was 2.7 weeks and 6.6 weeks, respectively, in the acute group and 4.6 weeks and 8.9 weeks, respectively, in the subacute group. All patients were satisfied with their outcome.


      Conservative management remains the gold standard for most simple elbow dislocations. We believe that certain high-demand patients may be candidates for acute arthroscopic ligamentous repair. Our preliminary data show that acute arthroscopic repair of the radial ulnohumeral ligament is a safe, effective procedure that restores stability to the elbow and allows patients to quickly return to full activities.

      Level of Evidence

      Level IV, therapeutic case series.
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        • Mehlhoff T.L.
        • Noble P.C.
        • Bennett J.B.
        • Tullos H.S.
        Simple dislocation of the elbow in the adult. Results after closed treatment.
        J Bone Joint Surg Am. 1988; 70: 244-249
        • Stoneback J.W.
        • Owens B.D.
        • Sykes J.
        • Athwal G.S.
        • Pointer L.
        • Wolf J.M.
        Incidence of elbow dislocations in the United States population.
        J Bone Joint Surg Am. 2012; 94: 240-245
        • O'Driscoll S.W.
        • Morrey B.F.
        • Korinek S.
        • An K.N.
        Elbow subluxation and dislocation. A spectrum of instability.
        Clin Orthop Relat Res. 1992; 280: 186-197
        • Josefsson P.O.
        • Johnell O.
        • Wendeberg B.
        Ligamentous injuries in dislocations of the elbow joint.
        Clin Orthop Relat Res. 1987; 221: 221-225
        • Josefsson P.O.
        • Gentz C.
        • Johnell O.
        • et al.
        Surgical versus nonsurgical treatment of ligamentous injuries following dislocation of the elbow joint: A prospective randomized study.
        J Bone Joint Surg Am. 1987; 69: 605-608
        • Hobgood E.R.
        • Khan S.O.
        • Field L.D.
        Acute dislocations of the adult elbow.
        Hand Clin. 2008; 24: 1-7
        • McCabe M.C.
        • Savoie F.H.
        Simple elbow dislocations: Evaluation, management, and outcomes.
        Phys Sportsmed. 2012; 40: 62-71
        • Ross G.
        • McDevitt E.R.
        • Chronister R.
        • Ove P.N.
        Treatment of simple elbow dislocation using immediate motion protocol.
        Am J Sports Med. 1999; 27: 308-311
        • Broberg M.A.
        • Morrey B.F.
        Results of treatment of fracture-dislocations of the elbow.
        Clin Orthop Relat Res. 1987; 216: 109-119
        • Kesmezacar H.
        • Sarikaya I.A.
        The results of conservatively treated simple elbow dislocations.
        Acta Orthop Traumatol Turc. 2010; 44: 199-205
        • Anakwe R.E.
        • Middleton S.D.
        • Jenkins P.J.
        • McQueen M.M.
        • Court-Brown C.M.
        Patient-reported outcomes after simple dislocation of the elbow.
        J Bone Joint Surg Am. 2011; 93: 1220-1226
        • O'Driscoll S.W.
        • Bell D.F.
        • Morrey B.F.
        Posterolateral rotatory instability of the elbow.
        J Bone Joint Surg Am. 1991; 73: 440-446
        • Regan W.
        • Lapner P.C.
        Prospective evaluation of two diagnostic apprehension signs for posterolateral instability of the elbow.
        J Shoulder Elbow Surg. 2006; 15: 344-346
        • Rettig A.C.
        Traumatic elbow injuries in the athlete.
        Orthop Clin North Am. 2002; 33: 509-522
        • Parsons B.O.
        • Ramsey M.L.
        Acute elbow dislocations in athletes.
        Clin Sports Med. 2010; 29: 599-609
        • Protzman R.R.
        Dislocation of the elbow joint.
        J Bone Joint Surg Am. 1978; 60: 539-541
        • Savoie III, F.H.
        • Field L.D.
        • Gurley D.J.
        Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow.
        Hand Clin. 2009; 25: 323-329
        • Savoie III, F.H.
        • O'Brien M.J.
        • Field L.D.
        • Gurley D.J.
        Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow.
        Clin Sports Med. 2010; 29: 611-618
        • Smith III, J.P.
        • Savoie III, F.H.
        • Field L.D.
        Posterolateral rotatory instability of the elbow.
        Clin Sports Med. 2001; 20: 47-58
        • Tegner Y.
        • Lysholm J.
        Rating systems in the evaluation of knee ligament injuries.
        Clin Orthop Relat Res. 1985; 198: 43-49
        • Kenter K.
        • Behr C.T.
        • Warren R.F.
        • O'Brien S.J.
        • Barnes R.
        Acute elbow injuries in the National Football League.
        J Shoulder Elbow Surg. 2000; 9: 1-5
        • Morrey B.F.
        • An K.N.
        Functional evaluation of the elbow.
        in: Morrey B.F. The elbow and its disorders. Ed 3. WB Saunders, Philadelphia2000: 82