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Congenital Absence of the Lateral Ulnar Collateral Ligament and Instability Treated with a Novel Internal Joint Stabilizer for the Elbow
Kristen M. Meier, MD; Steven M. Koehler, MD; Steven Andelman, MD; Michael R. Hausman, MD
Mount Sinai Medical Center, New York, NY

Introduction: The lateral ulnar collateral ligament (LUCL) is the primary lateral elbow stabilizer and functions to resist posterolateral stress. Posterolateral rotatory instability, subluxation, and dislocation of the elbow can occur with injury to the LUCL. The most common etiologies of instability are posttraumatic, iatrogenic, and chronic mechanical overload. Little has been reported regarding congenital absence of the LUCL as a cause for elbow instability.
Materials and Methods: A 12-year-old otherwise healthy, active female presented with painful, atraumatic bilateral elbow instability of unknown origin. Exam was significant for bilateral varus and posterolateral instability elicited with minimal force. Bilateral elbow MRI was significant for damage to the ulnohumeral cartilage and wear of the coronoid. Upon presentation the patient had already failed an attempt at bilateral reduction and external fixation. The patient was indicated for bilateral staggered open reduction and internal fixation. Intraoperatively during both cases, the patient was noted to have a band of tissue that lay anterior to the normal site of the LUCL. The tissue appeared to be intact but did not stabilize the elbow. A novel internal joint stabilizer (NIJS) was created from a distal radius variable angle locking plate. It was bent and twisted such that the distal locking screws were fixed to the proximal ulna and a partially threaded screw was placed through the axis of ulnohumeral rotation via the most proximal plate screw hole, thus creating an 'internal, external fixator' that permitted full range of motion. Tendon autograft was used for reconstruction of the LUCL using the docking technique. Postoperatively, the patient was permitted immediate full range of motion.
Results: To our knowledge, this is the first report of a patient with bilateral congenital absent LUCLs. Her pre and postoperative Mayo Elbow Performance Score (MEPS) improved from 35 to 75 for the right elbow and from 35 to 65 for the left elbow. Her DASH score improved from 73 to 9. At her most recent follow up (7 and 11 months) she had a stable flexion arc of 140 degrees and 110 degrees to the right and left elbow, respectively. Discussion and
Conclusion: We describe a new finding of congenital, bilateral absence of the lateral ulnar collateral ligament resulting in severe elbow instability. Our novel method of internal fixation and reconstruction of the lateral ulnar collateral ligament allowed this patient to obtain adequate pain-free motion and stability of her elbow.

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