APEX Elbow Mastering Surgical Techniques for Clinical Success-LUCL and Lateral Elbow Instability

Video Transcription

Video Summary

The speaker presents on lateral ulnar collateral ligament (LUCL) injury and lateral elbow instability, emphasizing posterolateral rotatory instability (PLRI) as a three-dimensional subluxation of the forearm (radius and ulna) that occurs with loading in supination. Diagnosis relies on a high index of suspicion because symptoms can be vague (clicking, discomfort, apprehension with weight bearing). Key exam maneuvers include the chair push-up test; the pivot-shift is often difficult in the office due to apprehension. X-rays help assess alignment and rule out fractures; MRI can be confirmatory but LUCL tears are hard to visualize directly, so indirect signs (radiocapitellar widening, radial head position) matter.<br /><br />A case is discussed: a 17-year-old athlete with recurrent traumatic elbow dislocations, hyperlaxity (Beighton 9/9), and positive chair test. Given chronicity and poor tissue quality intraoperatively, the surgeon performs open LUCL reconstruction (Coker approach) using an allograft and docking technique, tensions the graft at ~40–60° flexion in mid-pronation, and outlines a staged rehab with splinting, hinged brace, extension blocks, limited supination/abduction, and return to contact around 6 months.

Asset Caption

Moderator: Mandeep S. Virk, M.D.

Keywords

lateral ulnar collateral ligament (LUCL) injury

posterolateral rotatory instability (PLRI)

lateral elbow instability

chair push-up test

LUCL reconstruction with allograft docking technique

postoperative rehabilitation protocol