title: Direct repair for managing acute and chronic lateral ulnar collateral ligament disruptions.
abstract: OBJECTIVE
  Acute elbow injuries that disrupt the lateral ulnar collateral ligament and result in posterolateral rotatory instability usually require surgical treatment. The 2 technical options reported, direct repair and use of a palmaris longus tendon graft, have usually favored the use of the graft. To balance this emphasis, we report our experience with direct repair of the humeral origin in cases of trauma, whether acute, delayed, or recurrent. It was our hypothesis that because the humeral origin is the point of failure and separation, restoration of this attachment is sufficient to restore stability and durable function without the need for a graft.
  
  
  METHODS
  Patients with complete disruption of the posterolateral ligaments of the elbow, who were managed with direct repair to the humeral origin, were included. Patients were separated into an acute treatment group (< 30 d from injury to treatment) and a delayed treatment group (> 30 d). Mayo Elbow Performance Scores and postoperative range of motion were collected from patient records.
  
  
  RESULTS
  A total of 34 patients were included with a mean follow-up of 42 months. No difference was seen in Mayo Elbow Performance Scores between acute (mean, 90) or delayed treatment (mean, 89) of the lateral ulnar collateral ligament tear. No difference was seen in final elbow flexion or extension. Two patients in the acute group had failure of the direct repair requiring intervention. In the delayed group, no patients had recurrent instability.
  
  
  CONCLUSIONS
  No significant difference in clinical outcome or range of motion was observed after direct repair of traumatic tears of the lateral ulnar collateral ligament tear between acute and delayed treatment cohorts. Despite complete disruption of the posterolateral ligaments, direct repair of the torn ligament to its humeral origin was effective without supplemental tendon graft reconstruction irrespective of interval from injury to repair, mechanism of injury, or associated fractures.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY. Electronic address: daluiskia@hss.edu.
authors.forename: Aaron
authors.initials: A
authors.lastname: Daluiski
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schrumpf
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Schreiber
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Nguyen
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hotchkiss
mesh_terms: D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D017885:Collateral Ligaments / Q000293:injuries / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000601:surgery; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Posterolateral rotatory instability; lateral ulnar collateral ligament