Arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow (SMILE)

Knee Surg Sports Traumatol Arthrosc. 2017 Jul;25(7):2264-2270. doi: 10.1007/s00167-017-4531-9. Epub 2017 Mar 23.


Purpose: Minor instability has been proposed as a possible aetiology of lateral elbow pain. This study presents the results of the arthroscopic plication of the radial component of the lateral collateral ligament (R-LCL) to reduce minor instability of the lateral elbow.

Methods: Twenty-seven patients with recalcitrant lateral epicondylitis who had failed conservative therapy and who had no previous trauma or overt instability, were included. R-LCL plication was performed in the presence of at least one sign of lateral ligamentous patholaxity and one intra-articular abnormal finding. Single-assessment numeric evaluation (SANE), Oxford Elbow Score (OES), quickDASH (Disabilities of the Arm, Shoulder, Hand), patient satisfaction and post-operative range of motion were evaluated.

Results: SANE improved from a median of 30 [2-40] points pre-operatively to 90 [80-100] at final follow-up (p < 0.0001), and 96.3% patients obtained good or excellent subjective results. Post-operative median quickDASH was 9.1 [0-25] points and OES 42 [34-48]. Median post-operative flexion was 145°, and extension was 0°. Post-operative flexion was restrained in seven patients and extension in eight patients; 59% of patients reached full ROM at final follow-up.

Conclusions: R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with a symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up. A slight limitation in range of motion is a possible undesired consequence of this intervention.

Level of evidence: Retrospective case series, Level IV.

Keywords: Capsular plication; Elbow arthroscopy; Elbow instability; Lateral elbow pain; Lateral epicondylitis; Laxity.

MeSH terms

  • Adult
  • Arthralgia / etiology
  • Arthralgia / surgery
  • Arthroscopy / methods*
  • Collateral Ligaments / pathology
  • Collateral Ligaments / surgery*
  • Elbow
  • Elbow Joint / physiopathology
  • Elbow Joint / surgery*
  • Humans
  • Joint Instability / complications
  • Joint Instability / surgery*
  • Middle Aged
  • Patient Satisfaction
  • Range of Motion, Articular
  • Retrospective Studies
  • Tennis Elbow / physiopathology
  • Tennis Elbow / surgery*
  • Young Adult