Operative management of posterolateral rotatory instability in females: favorable 6-year outcomes in primary and revision elbows

Posterolateral rotatory instability (PLRI) is an instability pattern due to injury of the radial ulnohumeral ligament (RUHL) or lateral ulnar collateral ligament complex of the elbow. Recent literature has demonstrated that females may be more predisposed to this condition due to elevated levels of estrogen and progesterone. The purpose of this study was to analyze patient-reported outcome measures and return to a preinjury level of function for females who underwent operative management for PLRI. All females who underwent surgical management of the elbow at a single academic institution between 2011 and 2021 were retrospectively reviewed. Patients were included if they underwent arthroscopic or open repair/reconstruction of their RUHL. At final postoperative follow-up, patient-reported outcome measures including Single Assessment Numeric Evaluation (SANE) and Mayo Elbow Performance Score (MEPS) were obtained. Patients were asked whether their elbow had returned to a preinjury level of function, and athletes were asked whether they returned to sport postoperatively. Subsequent complications and surgeries were also recorded. A total of 37 patients (41 elbows) were analyzed, with 90.2% (37 of 41) having undergone RUHL repair and 9.8% (4 of 41) reconstruction. Sixty-one percent (25 of 41) had acute symptoms affecting their dominant elbow. Thirty-four percent (14 of 27) of patients underwent prior surgery to their affected elbow. At a mean follow-up of 6.1 ± 2.7 years, the mean SANE and MEPS of the entire cohort at final follow-up were 95.9 ± 8.5 and 86.3 ± 14.3, respectively. Based on the MEPS, 32 elbows had excellent or good outcomes, whereas 9 had fair or poor outcomes. Eighty-three percent (34 of 41) of patients stated that their elbow returned to a preinjury level of function, whereas 92.9% (13 of 14) of athletes were able to return to sport postoperatively. There was no significant difference in outcomes between those who were treated arthroscopically vs. with an open approach (P ≥ .331), acutely vs. chronically (P ≥ .538), and those who underwent primary vs. revision surgery (P ≥ .061). Females demonstrated favorable clinical outcomes at a mean follow-up of 6 years, with a majority of elbows returning to a preinjury level of function and sport, regardless of whether they underwent primary or revision surgery. In addition, there was no significant difference in outcomes for elbows treated arthroscopically or through an open approach. These findings support the efficacy of RUHL repair in females with PLRI and suggest that favorable outcomes can be achieved even in revision settings.