Arthrolysis of the Elbow and Reconstruction of the Collateral Ligaments Using a Fascial Strip of the Triceps

Objective Anatomic reconstruction of the collateral ligament of the elbow. Restoration of stability and function of the elbow. Reduction of pain. Improvement of range of motion. Indications Instability of elbow. Insufficiency of ulnar or radial collateral ligament. Loss of the capsuloligamentous apparatus as seen after extensive resection of heterotopic ossifications involving ligaments and capsule. Contraindications Unfavorable skin condition. Local infection. Damage to or previous operation of triceps tendon. Surgical Technique Posterior, posterolateral or posteromedial approach. Dissection while always protecting the ulnar nerve. A neurolysis or a subcutaneous transposition may become necessary. Resection as complete as possible of ossifications and removal of ossified radial/ulnar capsuloligamentous apparatus. Exposure of the superficial fascia of triceps up to the olecranon. Harvesting ofa fascial strip of the triceps 12 cm Ion 8 and 1.5 cm wide on either the radial or ulnar side or both, left attached to the olecranon. Anatomic triangular reconstruction of the collateral ligaments with the fascial strip. Transosseous fixation. Wound closure in two layers. Results In five patients, aged 25-59 years, an open arthrolysis combined with an ulnar triceps fascioplasty was done. In one instance it was combined with radial fascioplasty and once with a reconstruction of the radial collateral ligament using the tendon of the palmaris longus. Average duration of follow-up 2.2 years (8 months to 4-4 yea rs). Assessment criteria and results: Function: marked improvement. Subjective assessment: no instability. Joint stability: laxity of ulnar collateral ligament grade I in one patient. Pain: excellent pain reduction. Range of motion: marked increase.