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Anatomic annular ligament reconstruction using palmaris longus graft for hyper-pronation injury of the elbow with radial head dislocation

28 years old gentleman presented with 3 weeks old injury to the elbow following fall on outstretched hand. He complained of pain, swelling and restricted movement of the elbow. Examination revealed diffuse tenderness, swelling, healing bruise and painful and restricted movement of the elbow. There was no neurovascular deficit.

Plain radiograph revealed anterior dislocated radial head and incongruous ulnotrochlear joint. MRI scan revealed torn medial collateral ligament.

He was taken up for surgery. The elbow was opened through lateral approach. Radial head was found buttonholed through brachialis with empty radial notch and complete absence of annular ligament. The brachialis was flipped over the radial head, reducing proximal radio-ulnar joint. Palmaris longus tendon was harvested and prepared. The tendon graft was secured over anteromedial edge of radial notch with double loaded all-suture anchor, and over posterolateral edge of radial notch with knotless anchor (Arthrex), re-creating the annular ligament. The radial head was stable throughout the range of movement, and the same was confirmed on image intensifier.

Medial incision was taken when complete tear of common flexor origin and medial collateral ligament was found. The medial collateral ligament was repaired with knotless double loaded anchor at its anatomic footprint. Subsequently common flexor tendon was repaired.

Early range of movement exercise was initiated in ROM brace. The brace was discontinued in 6 weeks. At 2 months he regained full range of movement and was back to his function.