Arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow (SMILE).
OBJECTIVE
Minor instability has been proposed as a possible aetiology of lateral elbow pain. This study presents the results of the arthroscopic plication of the radial component of the lateral collateral ligament (R-LCL) to reduce minor instability of the lateral elbow.


METHODS
Twenty-seven patients with recalcitrant lateral epicondylitis who had failed conservative therapy and who had no previous trauma or overt instability, were included. R-LCL plication was performed in the presence of at least one sign of lateral ligamentous patholaxity and one intra-articular abnormal finding. Single-assessment numeric evaluation (SANE), Oxford Elbow Score (OES), quickDASH (Disabilities of the Arm, Shoulder, Hand), patient satisfaction and post-operative range of motion were evaluated.


RESULTS
SANE improved from a median of 30 [2-40] points pre-operatively to 90 [80-100] at final follow-up (p < 0.0001), and 96.3% patients obtained good or excellent subjective results. Post-operative median quickDASH was 9.1 [0-25] points and OES 42 [34-48]. Median post-operative flexion was 145°, and extension was 0°. Post-operative flexion was restrained in seven patients and extension in eight patients; 59% of patients reached full ROM at final follow-up.


CONCLUSIONS
R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with a symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up. A slight limitation in range of motion is a possible undesired consequence of this intervention.


METHODS
Retrospective case series, Level IV.
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.|U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy.
Paolo
P
Arrigoni
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy. d.cucchi@gmail.com.|U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy. d.cucchi@gmail.com.
Davide
http://orcid.org/0000-0001-6284-7977
D
Cucchi
IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy.
Riccardo
R
D'Ambrosi
IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy.
Alessandra
A
Menon
Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy.
Alberto
A
Aliprandi
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.|U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy.
Pietro
P
Randelli
D000328:Adult; D018771:Arthralgia / Q000209:etiology / Q000601:surgery; D001182:Arthroscopy / Q000379:methods*; D017885:Collateral Ligaments / Q000473:pathology / Q000601:surgery*; D004550:Elbow; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013716:Tennis Elbow / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
Capsular plication; Elbow arthroscopy; Elbow instability; Lateral elbow pain; Lateral epicondylitis; Laxity