PubMed^® Literature Review

The role of medial ligamentous stabilization in elbow dislocation when the radial head is repaired and the joint clinically stable is an intricate aspect of managing complex elbow instability [1-12]. The complexity arises due to the multifactorial nature of elbow stability, which involves bone articulation congruity, capsuloligamentous integrity, and muscle forces.

In cases where there is a fracture-dislocation involving both the radial head repair and coronoid process fixation (as part of "terrible triad" injuries or similar complex patterns), medial collateral ligament (MCL) repair may be necessary if clinical instability persists after lateral collateral ligament (LCL) repair [2][5][7]. This approach aims at restoring varus-valgus stabilizers alongside bony architecture reconstruction.

The MCL's contribution becomes particularly significant when addressing posteromedial rotatory instability—a condition often underappreciated but increasingly recognized as a critical component in complex elbow dislocations [8]. When associated with anteromedial facet fractures of the coronoid process along with LCL disruption resulting from varus posteromedial forces, MCL reconstruction can be pivotal for achieving joint stability [9].

Moreover, intraoperative assessment under fluoroscopy after radial head fixation/replacement reveals that some elbows remain unstable despite seemingly adequate osseous repairs. In these instances, direct repair or even reconstruction using tendon grafts for the MCL has been advocated by several authors [4][6][10]. It should be noted that persistent instability following LCL repair necessitates consideration for additional medial side intervention—either through direct repair or hinged external fixator application—if early mobilization within a stable arc is desired [3].

It's also important to highlight that while lateral-sided injuries are more common due to typical injury mechanisms leading to elbow dislocations with associated radial head fractures; however, neglecting potential damage on the medial side can lead to suboptimal outcomes such as recurrent instability or chronic valgus overload states leading eventually to arthritic changes [11].

The literature suggests that successful outcomes depend on achieving concentric reduction and maintaining it throughout early motion exercises postoperatively. This goal often requires meticulous attention not only to bony anatomy restoration but also careful evaluation—and subsequent treatment—of soft tissue structures including both collateral ligaments [12].

In summary, medial ligamental stabilization plays an adjunctive yet crucial role in certain cases where clinical stability cannot be achieved solely by addressing lateral column injuries alongside radial head repairs. The decision-making must be individualized based on intraoperative findings following initial osseous reconstructions coupled with dynamic testing for residual laxity or instability patterns