Rehabilitation of the Medial- and Lateral Collateral Ligament-deficient Elbow: An In Vitro Biomechanical Study

DESIGN: In vitro biomechanical research using an elbow motion simulator. INTRODUCTION: The optimal rehabilitation of elbow dislocations with medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries has not been defined. PURPOSE: To determine a safe rehabilitation protocol for elbow dislocations with MCL and LCL injuries. METHODS: Eight cadaveric elbows underwent simulated active and passive motions with the arm in multiple orientations. Varus-valgus angulation and internal-external rotation of the ulna relative to the humerus were quantified for the intact joint and with injured MCL and LCL. RESULTS: Active motion with injured MCL and LCL in the horizontal and vertical orientations resulted in kinematics similar to the intact elbow, whereas passive motion resulted in significant kinematic alterations. Marked elbow instability was noted in the varus and valgus orientations using both active and passive motion. CONCLUSIONS: Elbows with MCL and LCL injuries should be rehabilitated using active motion in the horizontal or vertical orientations. LEVEL OF EVIDENCE: Basic science research.