2025, Vol. 7, Issue 2, Part F

Background: Terrible triad injuries of the elbow frequently result in posterolateral rotatory instability (PLRI) due to disruption of the lateral ulnar collateral ligament (LUCL). Although fracture stabilization restores joint congruity, untreated ligament insufficiency often leads to recurrent instability, pain, and functional limitation. Reconstruction using tendon autograft is recommended in chronic symptomatic cases.

Methods: A prospective case series of three young adult male patients (aged 25-30 years) with PLRI following prior management of terrible triad injuries was conducted. All patients presented with recurrent instability during rehabilitation, characterized by activity-related pain, giving-way sensation, and apprehension during axial loading. Clinical tests including lateral pivot shift, chair push-up, table-top relocation, and posterolateral drawer tests were positive in all cases. MRI confirmed LUCL disruption (two mid-substance tears, one humeral avulsion). All patients underwent LUCL reconstruction using ipsilateral peroneus longus autograft via a modified Kocher approach. Postoperative rehabilitation focused on protected motion and progressive strengthening.

Results: All fractures were healed radiographically at presentation. Surgical reconstruction restored immediate stability without complications. Patients achieved pain-free range of motion and returned to activities of daily living by four months. One athletic patient resumed overhead sports at six months. No graft failures, stiffness, or donor-site morbidity were observed. All patients expressed high satisfaction with functional recovery and elimination of instability symptoms.