Acute severe valgus instability without elbow dislocation
- 이성문; 배기철; 조철현
- Alternative Author(s)
- Lee, Sung Mun; Bae, Ki Cheor; Cho, Chul Hyun
- Publication Year
- Elbow; Medial collateral ligament; Instability; Flexor-pronator tendon; Valgus
- Background: The purpose of this study was to investigate the pathoanatomy of acute valgus instability
without elbow dislocation and to evaluate clinical outcomes after operative treatment.
Methods: Seven patients presented with acute severe valgus instability without elbow dislocation or
fracture after a single traumatic episode. Five patients had primary repair of the medial collateral ligament
(MCL) and flexor-pronator tendon (FPT) with suture anchor. Two patients with highly unstable elbow had
primary repair of both the medial and lateral structures. On the basis of magnetic resonance imaging and
intraoperative findings, the injury patterns of the ligament, capsule, tendon, and bone structures were
evaluated. Clinical outcomes were assessed with the Mayo Elbow Performance Score and the shortened
Disabilities of the Arm, Shoulder, and Hand score.
Results: A complete tear of the MCL from its humeral origin and FPT was found in all patients. The anterior
capsule was also damaged. A stripping-type complete tear of the lateral collateral ligament complex
with significant instability was observed in 2 patients. Bone contusion at the capitellum or radial head was
found in 6 patients. The mean Mayo Elbow Performance Score and shortened Disabilities of the Arm,
Shoulder, and Hand score at final follow-up were 95.7 and 12.0. All patients returned to previous work
levels within 4 months after operation.
Conclusion: These results indicate that complete tears of both the MCL and FPT occur with severe valgus
instability. Primary repair of medial structures with suture anchor in acute severe valgus instability can
Level of evidence: Level IV, Case Series, Treatment Study.
2015 Journal of Shoulder and Elbow Surgery Board of Trustees.
Keywords: Elbow; medial collateral ligament; flexor-pronator tendon; valgus; instability
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