Elbow Ligament Reconstruction
The elbow is a hinge joint made up of 3 bones – the humerus, the radius and the ulna. The bones are held together by ligaments which provide stability to the joint. Muscles and tendons help in movements of the joint and in performing various activities. A deformity involving any of these structural components may result in instability or limitation of functional movement at the joint; this may require a surgical reconstruction to restore the normal function and stability of the elbow joint.
A deformity of the elbow joint may be congenital or acquired. Acquired deformity commonly results from trauma or injury which may include radial head and neck fractures, compound fractures and tear of the ulnar collateral ligament (UCL). Non-union of fractures may also result in deformity. The reconstruction surgery for correction of these deformities and restoration of function of the elbow joint may involve any of the following procedures:
- Replacement of the head of the radius in severe cases of radial head and neck fractures
- Use of Ilizarov fixators for correction of bone deformity: This involves the attachment of a circular external fixation frame to the bones of the elbow, with the help of pins or wires, to the bones that have been cut, at specific locations. The bone is gradually stretched during the healing process by the external fixator. The bone slowly grows and fills in the missing segment created by cutting the bone to correct the deformity.
UCL Reconstruction surgery involves the replacement of the torn ligament with a tendon, harvested from some other part of the body or from a cadaver. UCL Reconstruction surgery is performed in an operating room under local or general anesthesia. Donor tendon is harvested from either the forearm or below the knee; the most frequently used tendon is the Palmaris longus tendon from the forearm. An incision is made over the medial epicondyle and holes are drilled into the ulna and the humerus bones. The donor tendon is inserted through the drilled holes in a figure 8 pattern. The tendon is then attached to the bone surfaces with special sutures. The incision is closed with sutures and covered with sterile dressings. A splint is applied with the elbow flexed at 90 degree.