Anconeus Arthroplasty: A New Technique for Reconstruction of the Radiocapitellar and/or Proximal Radioulnar Joint

Author(s): Morrey BF, Schneeberger AG

Source: J Bone and Joint Surg, 84-A: 1960-1969, 2002

Summary:

This study is a retrospective review on the use of the anconeus muscle as an interpositional arthroplasty in 14 patients.  The anconeus was used in 3 different positions:  radiocapitellar joint (Type I), radiocapitellar and proximal radioulnar joints (Type II), and proximal radioulnar joint interposition (Type III).  Mean follow-up was 6.1 years (range, 2-11 years) However, 6 patients were only evaluated via telephone interview.  Five patients had radial head impingement, 4 had an Essex-Lopresti injury, 3 had a proximal radioulnar synostosis and 2 had juvenile rheumatoid arthritis.  The 4 with an Essex-Lopresti lesion also underwent a distal ulnar shortening procedure and in 4 patients the lateral collateral ligament complex was reinforced with a large suture through drill holes but without an autograft reconstruction.  The anconeus muscle blood supply, the recurrent posterior interosseous artery, was maintained.  Twelve of 14 patients reported a satisfactory subjective result with the Mayo Elbow Performance Score improving from 63 points preoperatively to 89 points postoperatively.  Forearm rotation averaged 69 preoperatively and 115 degrees at final follow-up.  The average extension-flexion arc improved from 34-123 degrees preoperatively to 19-127 degrees at final follow-up. 

These patients exhibited remarkably good outcomes following the treatment of very complicated problems related to the forearm and elbow including 4 chronic Essex-Lopresti injuries, 3 synostoses and 2 juvenile rheumatoid arthritis patients.   This paper introduces the use of the anconeus muscle, which has been limited in the past to primarily serving as a rotation flap for local wound defects and possibly for lateral epicondilitis reconstruction, to an interposition for problems related to the radiocapitellar and proximal radioulnar joints.  Certainly the results of this study will have to be confirmed at other institutions. 


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J Bone and Joint Surg