LUCL of Elbow Reconstruction
|Posted by Dr HC Chang under Elbow||
What is LUCL?
- The lateral collateral ligament (LCL) complex consists of the annular ligament the radial collateral ligament, the lateral ulnar collateral ligament (LUCL)The radial collateral ligament originates from the lateral epicondyle and terminates indistinguishably in the annular ligament, which stabilizes the proximal radioulnar joint.
- The LUCL originates from the lateral epicondyle, blending with fibers from the annular ligament but arching superficial and distal to it. This ligament is the primary restraint to varus stress and is deficient in posterolateral rotatory instability of the joint.
Injury to the LUCL causes Posterolateral Rotatory Instability of the Elbow
- Posterolateral rotatory instability of the elbow is a three-dimensional displacement pattern of abnormal external rotatory subluxation of the ulna coupled with valgus displacement on the humeral trochlea.
- This pattern causes the forearm bones to displace into external rotation and valgus during flexion of the elbow.
- Injury to the lateral ulnar collateral ligament allows abnormal supination of the ulna on the humerus.
- The radial head, being locked in the sigmoid (radial) notch of the proximal ulna by the annular ligament, subluxates posterior to the capitellum.
- The abnormality is usually posttraumatic and presents with locking, snapping, clicking, catching, and recurrent dislocation of the elbow.
What the Patient Experiences
- Abnormal clunk or locking of the elbow with certain activities.
- Apprehension when trying to get up from a chair using the arms to lift off.
- Recurrent elbow “dislocations”.
- The clinical diagnosis is suspected from history and confirmed by the physical examination, which includes the posterolateral rotatory instability test.
- This test often is best performed under general anaesthesia.
- Usually the instability is managed with either a repair of the ligament or an isometric reconstruction using a tendon graft.