A novel technique of annular ligament reconstruction using extensor carpi radialis longus tendon fascia: a report of 3 cases
Keywords:Annular ligament, Chronic radial head dislocation, Reconstruction, Extensor carpi radialis longus, Neglected
Annular ligament is an important stabiliser of radial head. In cases of chronic radial head dislocation, annular ligament reconstruction is warranted to maintain radial head reduction to improve elbow function. We have reported here a novel technique using the fascia overlying extensor carpi radialis longus tendon for annular ligament reconstruction. We reported an average flexion of 130º and full supination in all 3 cases. 2 patients achieved mid pronation and 1 achieved full pronation; comparable with other described techniques. Our novel technique through a single incision has excellent functional outcomes. Additionally, it is simple, cost effective, requires no hardware.
Gray H, In: Leatherette B, Warren H L, eds. Anatomy of the human body. 20th ed. Philadelphia: Lea and Febiger; 1918.
Zhang X, Gan RZ. Dynamic properties of human stapedial annular ligament measured with frequency-temperature superposition. J Biomech Eng. 2014;136(8): 0810041-7.
Cohen MS, Hastings H. Rotatory Instability of the Elbow. The Anatomy and Role of the Lateral Stabilizers. J Bone Joint Surg Am. 1997;79:225-33.
Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ. Ligamentous stabilizers against posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 2001;83(12):1823-8.
Søjbjerg J, Ovesen J, Gundorf C. The stability of the elbow following excision of the radial head and transection of the annular ligament. Arch Orthop Trauma Surg. 1987;106(4):248-50.
Bengard MJ, Calfee RP, Steffen JA, Goldfarb CA. Intermediate-term to long-term outcome of surgically and nonsurgically treated congenital, isolated radial head dislocation. J Hand Surg Am. 2012;37(12):2495-501.
Eygendaal D, Hillen RJ. Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children. Strategies Trauma Limb Reconstr. 2007;2(1):31-4.
Tawse AJB, The treatment of malunited anterior Monteggia fractures in children. J Bone Joint Surg Br. 1965;47(4):718-23.
Wang J, Jiang L, He A, Wang DR, Jhu J, Daun RS, et al. Annular ligament reconstruction by suture anchor for treatment of radial head dislocation in children. BMC Musculoskelet Disord. 2015;16:181.
Ghinea CA, Gavriliu S, Georgescu I, et al. Burnei's technique in the treatment of radial head displacement; innovative surgery. Study on two cases. J Med Life. 2013;6(1):26-33.
Lädermann A, Ceroni D, Lefèvre Y, De Rosa V, De Coulon G, Kaelin A. Surgical treatment of missed Monteggia lesions in children. J Child Orthop. 2007;1(4):237-42.
Delpont M, Jouve JL, Gauzy SJ, Louhaem D, Viale R, Bollini G, et al. Proximal ulnar osteotomy in the treatment of neglected childhood Monteggia lesion. Orthop Traumatol Surg Res. 2014;100(7):803-7.
Marinello PG, Wagner T, Styron J, Maschke S, Evans PJ. Annular Ligament Reconstruction with Triceps Autograft for Chronic Radial Head Instability. Tech Hand Up Extrem Surg. 2016;20(1):21-5.
Pari C, Puzzo A, Paderni S, Belluati A. Annular ligament repair using allograft for the treatment of chronic radial head dislocation: a case report. Acta Bio-medica: Atenei Parmensis. 2018;90(1):154-7.
Canton G, Hoxhaj B, Fattori R, Murena L. Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique. Musculoskeletal Surger. 2018;102(S1):93-102.
Kim HT, Park BG, Suh JT, Yoo CI. Chronic radial head dislocation in children, Part 2: results of open treatment and factors affecting final outcome. J Pediatr Orthop. 2002;22(5):591-7.
De Boeck H. Radial neck osteolysis after annular ligament reconstruction. A case report. Clin Orthop Relat Res. 1997;(342):94-8.