Pediatric Elbow Posterolateral Rotatory Instability: Novel Technique for Lateral Ulnar Collateral Ligament Reconstruction with All Suture Anchor Fixation

Description

In this video, Andrew Rees, an orthopedic surgical resident at Atrium Health in OrthoCarolina, presents a surgical technique for managing pediatric elbow posterolateral rotary instability (PLRI). He discusses the challenges of treating this rare condition and presents a novel approach for lateral ulnar collateral ligament (LUCL) reconstruction using all-suture anchor fixation.



Rees begins by outlining the clinical indications for this procedure, noting it is suitable for pediatric patients who experience multiple dislocation events and have chronic instability. He highlights that patients with non-reconstructible LUCL are better candidates for autograft reconstruction. The video follows the surgical steps undertaken on a seven-year-old male with chronic left elbow instability, detailing his history of multiple elbow injuries and persistent instability issues.



The surgical technique includes a careful approach to the elbow joint, meticulous preservation of the annular ligament, and the harvesting of a tendon graft from the flexor carpi radialis after confirming inadequate palmaris longus. He illustrates how drill holes were created for graft passage and the precise placement of a suture anchor for graft tensioning.



The video concludes with the postoperative rehabilitation plan, noting significant improvement in the patient's elbow function at three-month follow-up, including the return to normal activities like baseball. Rees emphasizes the importance of robust LUCL repair and the advantages of this innovative technique, which allows for precise reconstruction while protecting the growth plate in pediatric patients.

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