PLRI Eblow Reconstruction Technique

 
CPT Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms:

 PLRI Elbow Reconstruction CPT

  •  24344 (reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting graft). Associated ICD-9 codes: 726.3, 832.0-832.09, 841.1, 841.3

PLRI Elbow Reconstruction Indications

  • Recurrent PLRI of the elbow

 PLRI Elbow Reconstruction Contraindications

  • Acute injury: generally treated with direct repair.
  • Supracondylar maluion >15°
  • Coronoid deficiency
  • Open physis (children): imbrication/advancement indicated.
  • Advance osteoarthritis
  •  

PLRI Elbow Reconstruction Alternatives

  • Acute injury: generally treated with direct repair.
  • Supracondylar maluion >15°
  • Coronoid deficiency
  • Open physis (children): imbrication/advancement indicated.
  • Advance osteoarthritis

PLRI Elbow Reconstruction Pre-op Planning

  • Generally use plantaris tendon allograft.  May consider palmaris autograft

PLRI Elbow Reconstruction Technique

  • Sign operative site
  • Pre-operative antibiotics, +/- regional block
  • General endotracheal anesthesia
  • Lateral position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Perform elbow arthroscopy.
  • Perform lateral pivot shift test to confirm PLRI.
  • Perform arthroscopic valgus instability test (apply valgus stress with elbow in 70° of flexion while visualizing the medial ulnohumeral joint. Any opening >1mm indicates valgus instability which requires medial reconstruction).
  • 10cm lateral Kocher incision
  • Incise deep fascia along the supracondylar ridge proximally to the interval between the anconeus and ECU distally.
  • Expose supracondylar ridge by partially reflexing the triceps off the posterior humerus and the ECRL anteriorly.
  • Reflect the anconeus off the lateral ulna and caspsule.
  • Expose the LUCL insertion site near the tubercle on the supinator crest, distal to the annular ligament.
  • Graft tensioned with the elbow in 40° of flexion and full pronation.
  • Graft fixation may be done with absorbale interference screws. (arthrex biotenodesis)
  • Irrigate.
  • Close in layers.

PLRI Elbow Reconstruction Complications

  • Snapping / irritation of tendon graft
  • Continued instability
  • Neurovascular injury
  • Arthritis

PLRI Elbow Reconstruction Follow-up care

  • Post-op: Elbow is immobilized with a posterior splint with elbow in pronation.
  • 7-10 Days: Place in hinged elbow brace with forearm in pronation.
  • 6 Weeks: Pt may removed hinged brace for sedentary activities.
  • 3 Months: Progress with strengthening and ROM exercises. Sport specific rehab.
  • 6 Months: May return to sport.

PLRI Elbow Reconstruction Outcomes

 

  • 72% Excellent/good results 89% stable (Sanchez-Sotelo J, JBJS 2005;87Br:54).

PLRI Elbow Reconstruction Review References