Procedure demonstrated improved patient outcomes with a low complication rate.
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The Circumferential Graft Technique for Treatment of Chronic Multidirectional Ligamentous Elbow InstabilityThe circumferential graft technique withstood cyclic loading better than the conventional technique
Latest Surgical Technique
- Michael Hackl , MD
- Lars Peter Müller , MD, PhD
- Kilian Wegmann , MD, PhD
- Michael Hackl, MD1,a,
- Lars Peter Müller, MD, PhD1 and
- Kilian Wegmann, MD, PhD1
- 1Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
- ↵aE-mail address for M. Hackl:
Introduction The circumferential graft technique1,2 represents a potential option for the treatment of multidirectional ligamentous elbow instability using a single tendon graft (Video 1).
Indications & Contraindications
Step 1: Perform a Medial and Lateral Approach Approach the elbow joint through either a single posterior skin incision or separate lateral and medial incisions.
Step 2: Drill the Bone Tunnels Create humeral and ulnar bone tunnels for circumferential graft placement.
Step 3: Place the Graft Use a plantaris allograft, which we recommend; however, a semitendinosus autograft may also be used.
Step 4: Close the Wound Ensure that meticulous wound closure is achieved as it is key to preventing postoperative complications such as superficial or deep infection and persistent seroma.
Results As multidirectional instability represents a rather rare complication following ligamentous elbow dislocation, clinical data regarding the circumferential graft technique are scarce1,2.
Pitfalls & Challenges
The circumferential graft technique1,2 represents a potential option for the treatment of multidirectional ligamentous elbow instability using a single tendon graft (Video 1).
While early functional treatment can be considered the gold standard for the management of ligamentous or “simple” elbow dislocation, with good clinical results in most patients3, some who have more extensive soft-tissue trauma and/or subsequent dislocations may have gross instability of the elbow. In patients who have persistent disability with insufficiency of both the lateral and the medial collateral ligament complex, ligament reconstruction is warranted in order to restore the joint stability and improve the functionality of the affected arm.
The circumferential graft technique was initially reported in 2006 by van Riet et al.2 and separately in a series of 14 patients described by Finkbone and O’Driscoll1. This technique aims to restore …