Radial notch labralization for proximal radioulnar joint dysplasia.

ABSTRACT

BACKGROUND: Chronic posterior subluxation or dislocation of the radial head is uncommon and difficult to treat. To restore radiocapitellar alignment, procedures such as deepening of the notch using a high-speed burr have been described, but they can result in cartilage damage. We hypothesized that a radial notch labralization using soft tissue could improve radiocapitellar tracking without violating the joint surface. METHODS: A radial notch labralization was performed in 3 patients with chronic posterior subluxation of the radial head and developmental dysplasia of the radial notch in the setting of complex recurrent instability of the elbow. A soft tissue graft (typically a portion of an allograft hamstring tendon) was used to create a meniscus-like bumper posteriorly, thereby deepening the radial notch and reducing its radius of curvature. A corrective anterior opening wedge ulnar osteotomy was also performed to realign the radial head with the capitellum. RESULTS: At a mean follow-up of 32 months, all 3 patients were pain free and had maintained a stable joint, with a functional range of motion. Each patient gave a rating of either "Greatly Improved" or "Almost Normal" on the Summary Outcome Determination scale. Radiographs performed during the last follow-up showed improved radiocapitellar alignment. CONCLUSION: Chronic posterior subluxation or dislocation of the radial head can occur subsequent to developmental joint changes. The radial notch labralization using a soft tissue graft associated with a corrective ulnar osteotomy was successful in restoring radial head stability and avoiding cartilage damage.