Surgical Discussion

I did an open reduction of the elbow and LCL/MCL ligament repair. He did well initially and saw me at 5 months postop and mentioned that when he fully extends his elbow he feels a click in his elbow. He had no pain, with ROM of 10-145, 70/70. His xrays showed medial joint space narrowing from the joint subluxation that was evident on subsequent sagittal CT views. When I examined him under fluoro in the OR, his elbow was stable to varus and valgus stress test but clear subluxation when I fully extended the elbow. I ended up doing a coronoid reconstruction with annular portion of a radial head allograft. Deficiency of pMCL may certainly have contributed but I did not reconstruct that. I had repaired the lateral and anterior bundle of MCL in the initial surgery and when I did intraoperative live fluoro assessment there was no laxity with varus or valgus stress test and again after I reconstructed the coronoid the elbow was stable with varus and valgus and did not subluxate even in extension. He's 3 months out. His clicking and grinding is gone.