Elbow lateral ulnar collateral ligament repair (LUCL repair)

You have undergone surgery for lateral ulnar collateral ligament repair of the elbow with Kemble Wang.

This ligament is usually injured as a result of trauma such as a fall, although can also be related to abnormal growth, or following previous elbow surgery. 

This is an important ligament that controls stability of the lateral aspect (outer side) of the elbow. The injury frequently occurs in conjunction with a fracture of the radial head and/or dislocation of the elbow. These other structures may also have been repaired by Kemble. 

The following is a schematic diagram of the LUCL, as well as an intraoperative photograph of an LUCL repair following an elbow dislocation

Post-operative rehabilitation (developed in conjunction with Nick Antoniou Hand Therapy)

Goals:

  1. Protect healing structures (LUCL)

  2. Prevent subluxation of radial head/elbow joint

  3. Decrease pain and inflammation

  4. Restore elbow ROM in protected position during healing phase

  5. Restore posterolateral elbow stability

 

Evaluation

  1. Wound

  2. Oedema

  3. AROM – in overhead (supine) position

  4. Impact of any other concomitant or associated injuries

 

Initial Phase (0-4 weeks)

Initial appointment (10-14 days post-operatively)

  • Remove post-operative dressing and primary dressing of wound

  • Apply tubigrip (or similar) to elbow to reduce post-operative swelling

  • Commence scar management if suitable

  • Commence overhead elbow protocol (in supine) consisting of active

    • elbow flexion and extension (in pronation)

    • forearm rotation (with elbow flexed 90 degrees) and

    • wrist extension and flexion

  • Continue with sling full-time except for hygiene and exercises.

  • (OPTIONAL – combine with hinged elbow brace limited to 30 degrees extension, dependent on surgeon preference)

  • Elbow Varus Precautions:

    • avoid shoulder abduction and internal rotation

    • avoid full elbow extension combined with forearm supination

    • when sleeping a pillow is placed between the affected arm and torso (when lying on back) or several pillows placed under elbow when side lying (on opposite side)

 

  • if excessive pain or unexpected stiffness in motion – suggest xrays to check for subluxation of joint

 

Intermediate Phase

 

Review Appointment (4 -6 weeks post-operatively)

  • Commence active elbow flexion and extension (including gravity assisted) with forearm in neutral and/or pronated position during elbow extension phase in a seated or standing position.

  • Commenced active and gentle passive forearm rotation in a seated or standing position with the elbow flexed. Avoid forced forearm supination

  • Continue with elbow varus precautions

  • Cease sling (and hinged elbow brace if previously fitted)

  • No functional use of arm permitted during this period.

 

Review Appointment (6-8 weeks post-operatively)

  1. Commence passive elbow flexion and extension exercises in both pronation and supination

  2. Cease elbow varus precautions at 8 weeks

  3. Commence light functional activity (up to 3 kgs maximum lift or weightbearing)

 

Advanced Phase

Review Appointment (8-12 weeks post-operatively)

  • Commence strengthening and conditioning exercises of the elbow, forearm and wrist

  • Commence ROM restoration splinting or strapping (dynamic or static progressive) for restricted elbow flexion or extension

  • Commence gentle weightbearing conditioning exercises

  • Full return to sports and heavy activities at 12 weeks

 

  • Additional: if concomitant radial head replacement, limit functional activity to 5kg until 6 months to allow bony integration of implant

 

 

Possible Complications

  • Early subluxation of radial head/elbow joint (posterolateral rotatory instability)

  • Elbow flexion contracture (capsular tightness of anterior capsule, or posterior/lateral bony block)

  • Elbow extension contracture (triceps tightness and/or posterior capsule, or anterior bony block)

  • late posterolateral rotatory instability

©2020 Kemble Wang Orthopaedics

 

Disclaimer: All information provided on this webpage should be considered as general guidelines. Actual practice and (expected) outcomes may differ in your case. The contents has been created online for information purposes only. It is not intended to be a substitute for professional medical advice.