Medial and Lateral Collateral Ligament Repair or Reconstruction of the Elbow

The elbow is a complex hinge joint relying on bony and soft tissue restraints for stability. The primary soft tissue stabilizers are the medial and lateral collateral ligament complexes. Injury to these structures may occur because of an elbow dislocation or due to a severe varus or valgus force. Most injuries are treated conservatively, but when associated with more severe soft tissue and bony injuries around the elbow, surgical repair or reconstruction may be required. Repair should be anatomical and should restore stability to the elbow so that early active range of motion can be initiated. Reconstruction may be required in severe cases and where primary repair is not possible. Knowledge of the normal anatomy and understanding the pathoanatomy is crucial to achieving a good result. Depending on the degree of instability, either one or both of the collateral ligament complexes may need to be repaired or reconstructed. When reconstruction is required, usually only the lateral ulnar collateral and the anterior band of the medial collateral ligament need to be reconstructed, but when severely unstable, the posterolateral capsule and the posterior band of the medial collateral ligament may also require reconstruction. This may be accomplished by 2 separate grafts or as a single circumferential graft. Arthroscopy is a valuable tool to assess the stability as well as to identify and treat associated injuries. This article describes the normal and pathoanatomy of the unstable elbow and outlines the surgical techniques for repair and reconstruction of the collateral ligaments.