title: Release of the medial collateral ligament to improve flexion in post-traumatic elbow stiffness.
abstract: Contracture of the collateral ligaments is considered to be an important factor in post-traumatic stiffness of the elbow. We reviewed the results of isolated release of the medial collateral ligament in a series of 14 patients with post-traumatic loss of elbow flexion treated between 1998 and 2002. There were nine women and five men with a mean age of 45 years (17 to 76). They were reviewed at a mean follow-up of 25 months (9 to 48). The operation was performed through a longitudinal posteromedial incision centred over the ulnar nerve. After decompression of the ulnar nerve, release of the medial collateral ligament was done sequentially starting with the posterior bundle and the transverse component of the ligament, with measurement of the arc of movement after each step. If full flexion was not achieved the posterior half of the anterior bundle of the medial collateral ligament was released. At the latest follow-up, the mean flexion of the elbow improved significantly from 96 degrees (85 degrees to 115 degrees ) pre-operatively to 130 degrees (110 degrees to 150 degrees ) at final follow-up (p = 0.001). The mean extension improved significantly from 43 degrees (5 degrees to 90 degrees ) pre-operatively to 22 degrees (5 degrees to 40 degrees ) at final follow-up (p = 0.003). There was a significant improvement in the functional outcome. The mean Broberg and Morrey score increased from a mean of 54 points (29.5 to 85) pre-operatively to 87 points (57 to 99) at final follow-up (p < 0.001). All the patients had normal elbow stability. Our results indicate that partial surgical release of the medial collateral ligament is associated with improved range of movement of the elbow in patients with post-traumatic stiffness, but was less effective in controlling pain.
authors.affiliation: Department of Orthopaedic Surgery, Duke University, DUMC 3466, Durham, North Carolina 27710, USA. d.ruch@duke.edu
authors.forename: D S
authors.initials: DS
authors.lastname: Ruch
authors.forename: J
authors.initials: J
authors.lastname: Shen
authors.forename: G D
authors.initials: GD
authors.lastname: Chloros
authors.forename: E
authors.initials: E
authors.lastname: Krings
authors.forename: A
authors.initials: A
authors.lastname: Papadonikolakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017885:Collateral Ligaments / Q000601:surgery*; D003286:Contracture / Q000503:physiopathology / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D000092464:Elbow Injuries