Valgus Instability of the Elbow Due to Medial Epicondyle Nonunion: Treatment by Fragment Excision and Ligament Repair-A Report of 5 Cases

Author(s): Gilchrist AD, McKee MD

Source: J Shoulder Elbow Surg 11: 493-7, 2002

Summary:

This is a series of 5 cases reported in a case-cohort fashion.  All patients had sustained an avulsion fracture of the medial epicondyle at a mean of 10 years prior to the presentation.  All had chronic signs of valgus instability of the elbow, including weakness and instability with weight-lifting or overhead activity.  In addition, patients reported an inability to throw without pain.  Physical findings demonstrated tenderness over the medial epicondyle and pain with valgus stress testing.  Radiographic evaluation demonstrated a non-union of the epicondyle in all cases.  The authors advocate excision of the epicondyle and careful repair of the medial collateral ligament to the remaining condyle using suture anchors. Of note, the authors were careful to locate the isometric point of the medial collateral ligament using elbow flexion and extension.   Results indicate that the patients recovered stability of the elbow to moderate stress, including lifting weights and valgus stress testing. One patient who went back to competitive throwing required augmentation and repair with an autogenous tendon graft.

These authors conclude that this technique resulted in an earlier return of stability for patients with chronic insufficiency due to a medial epicondylar fracture with loss of integrity of the medial collateral ligament.  The technique presented is a viable option for this rare condition when symptomatic.   Surgical indications, however, require pain or functional problems with vigorous valgus loading of the joint.  In the absence of symptoms, medial elbow ligament instability is often well tolerated from a functional standpoint.

 
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J Shoulder Elbow Surg