Split Anconeus Fascia Transfer for Posterolateral Rotatory Instability of the Elbow

Posterolateral rotatory instability (PLRI) of the elbow occurs from chronic lateral ulnar collateral ligament (LUCL) injury leading to subluxation of the ulnohumeral joint and radial head. Patients with failed or untreated LUCL injury can go on to have chronic elbow instability and difficulty with activities that require an axial load on the elbow. Free grafts such as semitendinosus, Achilles, or palmaris longus require fixation on both the humerus and ulna, or may not represent the native LUCL kinematics as a native tendon such as anconeus. Split anconeus fascia transfer is a surgical treatment option for PLRI that does not require ulnar drilling or graft site morbidity. This surgical technique paper describes evaluation, management, and treatment of PLRI with accompanying video and description of the split anconeus fascia transfer technique.