This review defines posterolateral rotatory instability (PLRI) of the elbow, the most common recurrent instability pattern after elbow dislocation. It covers the relevant lateral ligamentous anatomy, the pathomechanics driven by LUCL insufficiency, the diagnostic pivot shift test, and surgical repair versus reconstruction.
When a patient reports recurrent clicking, locking, or a feeling the elbow slides out, especially after a prior dislocation, think PLRI and perform the pivot shift test. The mental model: LUCL insufficiency lets the ulna supinate on the trochlea, and the annular ligament drags the radial head posterior to the capitellum. Maximal subluxation occurs near 40 degrees of flexion.
Because apprehension frequently blocks a clean exam, confirm subtle instability under fluoroscopy, sedation, or general anesthesia. A key surgical pearl: the Kocher and Boyd approaches violate the LCL complex, so failing to repair it at closure causes iatrogenic PLRI. Always reattach the lateral complex.
Management follows tissue quality. Repair torn ligament when adequate tissue exists; use an isometric autograft reconstruction when it does not. Counsel patients that an intact radial head and absence of arthritis predict roughly 90% satisfactory outcomes.
This review defines posterolateral rotatory instability (PLRI) of the elbow, the most common recurrent instability pattern after elbow dislocation. It covers the relevant lateral ligamentous anatomy, the pathomechanics driven by LUCL insufficiency, the diagnostic pivot shift test, and surgical repair versus reconstruction.
When a patient reports recurrent clicking, locking, or a feeling the elbow slides out, especially after a prior dislocation, think PLRI and perform the pivot shift test. The mental model: LUCL insufficiency lets the ulna supinate on the trochlea, and the annular ligament drags the radial head posterior to the capitellum. Maximal subluxation occurs near 40 degrees of flexion.
Because apprehension frequently blocks a clean exam, confirm subtle instability under fluoroscopy, sedation, or general anesthesia. A key surgical pearl: the Kocher and Boyd approaches violate the LCL complex, so failing to repair it at closure causes iatrogenic PLRI. Always reattach the lateral complex.
Management follows tissue quality. Repair torn ligament when adequate tissue exists; use an isometric autograft reconstruction when it does not. Counsel patients that an intact radial head and absence of arthritis predict roughly 90% satisfactory outcomes.