Return-to-sports after conservative treatment of ligamentous elbow dislocations: a monocentric retrospective cohort study. European journal of trauma and emergency surgery.

Abstract

Purpose: Ligamentous elbow dislocations often affect young patients with high functional and athletic demands. After reduction and clinical examination of joint stability, further treatment options are, therefore, the subject of controversial debate. In order to be able to advise patients adequately, an assessment of the possible return-to-sport based on experience is necessary. This study examines the medium to long-term return-to-sports after conservative treatment of a ligamentous elbow dislocation.

Methods: In this clinical study, 42 patients (47.6% female, 52.4% male) who were treated conservatively for a ligamentous elbow dislocation at our clinic were surveyed. Conservative treatment was carried out for at least 6 weeks. Exclusion criteria were concomitant bony lesions requiring surgery, a tendency to dislocate between 30 and 130° of flexion after reduction, a positive apprehension test after reduction, and athletes with medial pop-up/instability and high valgus stress as part of their sporting activities. The Disabilities of the arm, shoulder and hand (DASH), the sport-DASH and the subjective elbow value (SEV) were tested. The sport-DASH was correlated with gender, age, arm dominance, and the type of sport practiced. Descriptive statistics and significant differences were determined using statistical analyses.

Results: The average age was 42.7 years (range 22-75). After an average follow-up after 4.5 years, the mean value of DASH was 2.44 (SD 4.77), the mean value of sports DASH was 4.17 (SD 11.04) and the mean value of SEV was 94.93% (SD 6.40). There were no significant differences in sports DASH depending on gender (p = 0.81), age (p = 0.68), dislocation side in relation to the dominant arm (p = 0.54) or the type of sport practiced (p = 0.94, p = 0.65, p = 0.71). 2 patients (4.8%) underwent surgery after 6 and 8 weeks of conservative treatment due to persistent elbow stiffness.

Conclusion: In our patient cohort, a very good return-to-sports after conservative treatment of ligamentous elbow dislocation was demonstrated, taking into account the above exclusion criteria. Factors such as age, gender, the side of the dislocation in relation to the arm dominance, and the type of sport had no influence on the outcome of our study. The data help practitioners to advise patients better when deciding on treatment and the question of a possible return to sport.