The elbow is inherently a stable joint but trauma and attrition of ligaments because of deformity can render an elbow unstable in extremes of range. In low demand individuals this may be tolerated reasonably well and strengthening of the muscles around the elbow with physiotherapy can do a lot for instability. In higher demand patients and where the degree of instability is such that function is compromised or sporting goals are limited, surgery may be necessary.
Elbow instability is a complex problem and the pattern of instability varies from patient to patient but by far the most common in Ireland is instability because of failure of the outer elbow ligaments. Imaging with MRI and sometimes CT can be useful in interpreting the defect but an examination under anaesthesia (EUA) or even a diagnostic arthroscopy (keyhole evaluation of the joint) is often necessary for definitive diagnosis and surgical planning.
Strapping and rehab of specific muscle groups to help with joint stability is the first line. If this doesn’t work, then confirmation of the injury pattern through diagnostic examination under anaesthesia with or without arthroscopy is the next step. After this, planning of the necessary reconstruction can be done and I will discuss the options with you at your post EUA consultation.
Typically, reconstruction involves taking a tendon graft from elsewhere in your body, or occasionally a tendon graft from the bone bank, and inserting it into your elbow to replace the defective ligament. Anchors or similar devices are usually used to hold the new ligament in place while it heals. Release or transposition of nerves may be necessary as part of the procedure.
Initially you will be in a brace or cast to immobilise the elbow. However, we always aim to get the elbow moving as early as possible. There is a rehab protocol that allows movement but protects the ligament during this phase. The protocol varies depending on the ligament involved and requires close supervision with your physio or occupational therapist. One would expect the ligament to be able to tolerate load after 12 – 15 weeks.
Return to sport usually takes in the order of 5 months but for higher-level athletes this process may take longer depending on demand. A graduated rehab program is the norm. Assessment of progress during post-operative physio and surgical consultations will determine the exact return to play time.
Physios: see our therapy guidelines for post-operative care