Box-loop technique in the management of complex elbow instability: A prospective controlled trial

Introduction: Chronic elbow instability is a disable complication. This prospective study reports our experience with the box-loop reconstruction technique, compared with traditional Lateral Collateral Ligament (LCL) and eventual Medial Collateral Ligament (MCL) reconstruction, showing its functional outcome at 12-month follow-up. Methods: From January 2013 to February 2017, 27 patients with complex elbow instability were recruited. Group-A patients were managed using box-loop technique; in Group-B patients LCL reconstruction was performed and MCL lesions were always intraoperatively tested, under fluoroscopy, and eventually treated. Clinical evaluations were performed at baseline (T0) and at 1- month (T1), 6-month (T2) and 12-month (T3) follow- up. X-rays were performed at T0 and T3. Intergroup and intragroup variability was assessed. Results: In all the patients, an improvement of both the range of movement and the joint stability was observed after surgery. The mean increase in flexion-extension arch was 52° in Group-A patients at 12-month follow-up. A significant improvement (p<0.05) of Mayo Elbow Performance Score, Oxford Elbow Scores and Visual Analogue Scale was observed at 12-month follow-up in both groups. Conclusion: Box-loop technique revealed safe and effective in the management of multidirectional elbow instability.