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The Journal of Bone and Joint Surgery (American) 84:1960-1969 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Anconeus Arthroplasty: A New Technique for Reconstruction of the Radiocapitellar and/or Proximal Radioulnar Joint

Bernard F. Morrey, MD and Alberto G. Schneeberger, MD

Investigation performed at the Mayo Clinic, Rochester, Minnesota

Bernard F. Morrey, MD
Mayo Clinic, 200 First Street S.W., Rochester MN 55905. E-mail address: morrey.bernard{at}mayo.edu

Alberto G. Schneeberger, MD
Department of Orthopaedic Surgery, University of Zurich, Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Management of posttraumatic radiocapitellar and/or proximal radioulnar joint dysfunction and pain is a challenging problem, often with more than one pathological feature, and to date there are no consistently reliable solutions. The unreliability of prosthetic replacement prompted us to develop an anconeus arthroplasty wherein the anconeus muscle is rotated into the radiocapitellar and/or proximal radioulnar joint.

Methods: Three interposition options were assessed in our laboratory and were employed clinically: interposition at the radiocapitellar joint (Type I), interposition at the radiocapitellar and proximal radioulnar joints (Type II), and proximal radioulnar interposition (wrap) (Type III). The clinical outcomes in fourteen patients who had been treated with one of the three types of anconeus interposition arthroplasty were reviewed at least two years (mean, 6.1 years) postoperatively.

Results: Anatomic dissection of twenty-five specimens revealed that all three applications were possible. Of the fourteen patients, twelve (all six with a Type-I interposition, three of the five with a Type-II interposition, and all three with a Type-III interposition) had a satisfactory overall subjective result. The Mayo Elbow Performance Score averaged 63 points before the surgery and 89 points after it.

Conclusions: Anconeus interpositional arthroplasty offers a reasonable likelihood of improved subjective and objective function in patients with the challenging problem of radiocapitellar and/or proximal radioulnar joint dysfunction and pain after trauma, even when there is Essex-Lopresti axial instability.


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