This study is a retrospective review of 7 patients identified with posterolateral rotatory instability of the elbow following radial head resection. These patients were identified from 42 patients between November of 1995 and September of 2000 who presented to the senior author with lateral elbow pain following a radial head resection. The diagnosis was based on the following criteria: 1) history of radial head resection; 2) symptoms of lateral elbow pain, weakness and perceived instability; 3) a positive lateral pivot shift test including a posterolateral dimple just proximal to the radial neck stump and apprehension during the supination phase of the test; 4) radiographic evidence of posterolateral rotatory instability including posterior subluxation of the radial neck and/or ulnohumeral joint space widening; 5) insufficiency of the lateral collateral ligament on direct visualization surgically or by examination. There were 5 men and 2 women with a mean age of 42 years (range, 29 to 47 years). The preoperative mean arc of flexion-extension was 103 degrees (range, 50 to 130 degrees). One patient had advanced degenerative change in association with posterior subluxation of the ulnohumeral joint. Three patients had evidence of subluxation of the radial shaft on plain radiographs. Four patients underwent operative reconstruction. One patient underwent autogenous lateral ligament reconstruction with local soft tissues alone which was judged to be a failure because of persistent instability and lateral elbow pain. This patient subsequently underwent radial head replacement. Two other patients were treated with a titanium radial head replacement with lateral autogenous tendon graft ligamentous reconstruction. One patient with advanced degenerative joint disease underwent a semiconstrained total elbow arthroplasty with a good result. There were no apparent complications or recurrences.
This study confirms the potential development of posterolateral rotatory instability following radial head resection. The authors’ report good results following radial head replacement and lateral collateral ligament reconstruction/repair. However, this study does not identify the prevalence of posterolateral rotatory instability following radial head resection. In addition, these patients presented because of complaints of pain and subjective feelings of instability. However, it is uncertain whether some patients have asymptomatic posterolateral rotatory instability following radial head resection and don’t present for evaluation. The authors recommend that if an avulsion of the lateral ligamentous structures of the posterolateral aspect of the distal part of the humerus is identified at the time of surgery, then the ligament should be repaired to bone and an attempt made to repair or replace the radial head to prevent this potential complication.
J. Bone and Joint Surgery