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Knott K, Leinfelder S, Schultz R, Balzer A, Palisch AR. MRI spectrum of injuries to the thumb metacarpophalangeal joint ulnar collateral ligament with a proposed expanded classification of injuries in American football players. Skeletal Radiol 2024; 53:1255-1268. [PMID: 38110778 DOI: 10.1007/s00256-023-04539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint are of both historic and modern interest for athletes and non-athletes alike. The thumb metacarpophalangeal joint requires stability in both flexion and extension utilizing a combination of static and dynamic stabilizers. This article reviews the magnetic resonance imaging categorization of thumb ulnar collateral ligament injuries and proposes two additional injury patterns seen in high-level and professional athletes who play American football. In addition to the direct magnetic resonance imaging findings in collateral ligament tears, secondary findings of rotation and subluxation can be seen at the thumb metacarpophalangeal joint due to the altered physiologic forces on the joint. Internal brace augmentation via suture tape of a traditional ulnar collateral ligament repair is a novel surgical technique that provides protection during initial healing and the ensuing remodeling phase following repair or reconstruction, resulting in a faster return to play.
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Affiliation(s)
- Kemp Knott
- Department of Radiology, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Stephen Leinfelder
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, 22098, USA
| | - Ryan Schultz
- Department of Radiology, University of Missouri, Columbia, MO, 65211, USA
| | - Anthony Balzer
- Department of Radiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Andrew R Palisch
- Department of Radiology, University of Missouri, Columbia, MO, 65211, USA
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2
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Barrera-Ochoa S, Cavaca R, Sapage R, Martínez-Garza J, Prieto-Mere J, Mendez-Sanchez G. Biological Versus Nonbiological Reconstruction of the Ulnar Collateral Ligament of the Thumb Metacarpophalangeal Joint: A Retrospective Study. J Hand Surg Am 2024; 49:432-442. [PMID: 38506782 DOI: 10.1016/j.jhsa.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/28/2023] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE The purpose of this study was to compare clinical and radiologic outcomes of biological ligament reconstruction (BLR) versus nonbiological ligament reconstruction (NBLR) for chronic injuries involving the ulnar collateral ligament of the thumb's metacarpophalangeal joint. METHODS Forty-two patients who underwent static BLR (n = 24) or NBLR (n = 18) were included in this retrospective analysis. Preoperative, postoperative, and contralateral thumb measurements (clinical evaluation, radiographs, and subjective outcome questionnaires) were compared over a mean of 38 months of follow-up. RESULTS Average postoperative thumb metacarpophalangeal and interphalangeal joint ranges of motion were 2° to 54° and 0 to 71°, respectively, for BLR and 0° to 58° and 0° to 71°, respectively, for NBLR. Average grip and pinch strengths, relative to the unaffected hand, were 102% and 84% versus 103% and 89%, respectively. All patients demonstrated stability with a firm end point, compared with the unaffected thumb. The average Quick Disabilities of the Arm, Shoulder, and Hand score among all patients was 12 for the disability/symptom module, 0 for the sports module, and 17 for the work module. Stiffness was reported among four patients, and no patient sustained wound-related issues or other complications. CONCLUSIONS Nonbiological ligament reconstruction of the thumb ulnar collateral ligament generates short-term outcomes comparable with those of BLR, potentially allowing for expedited recovery and rehabilitation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Sergi Barrera-Ochoa
- Institut de la Mà, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Rita Cavaca
- Institut de la Mà, Hospital Universitari General de Catalunya, Barcelona, Spain; Orthopedic and Traumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Rita Sapage
- Institut de la Mà, Hospital Universitari General de Catalunya, Barcelona, Spain; Orthopedic and Traumatology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | | | - Jose Prieto-Mere
- Institut de la Mà, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Gerardo Mendez-Sanchez
- Institut de la Mà, Hospital Universitari General de Catalunya, Barcelona, Spain; Orthopedic and Traumatology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
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3
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Knisely B, Noland SS, Melville DM. Ultrasound versus MRI in the evaluation of the thumb metacarpophalangeal joint. J Ultrason 2023; 23:e214-e222. [PMID: 38020517 PMCID: PMC10668926 DOI: 10.15557/jou.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
An intricate and unique combination of ligamentous, fibrocartilaginous, and osseous structures stabilize the thumb metacarpophalangeal joint. Both ultrasound and high-resolution magnetic resonance imaging are extremely useful in evaluating these critical structures. This article reviews common injuries of the thumb metacarpophalangeal joint, while highlighting the merits, limitations, and pitfalls of the two imaging modalities. A clear appreciation of each method, paired with anatomic knowledge, will lend greater confidence and accuracy to diagnosing impactful injuries and guiding intervention.
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Li J, Ghulam-Jelani Z, Hoekzema N. Peri-articular fractures of the hand. J Hand Surg Eur Vol 2023; 48:35S-41S. [PMID: 37704023 DOI: 10.1177/17531934231184132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Peri-articular fractures of the hand are common injuries. Long-term consequences can be relatively innocuous or severely disabling. Due to the specific anatomy of the hand, avulsion fractures are likely more common here than anywhere else in the body and often occur at or near joints. The management of peri-articular fractures of the hand requires consideration of both the articular reduction and the status of ligament and tendon attachments. In general, these fractures can be treated non-operatively. Operative treatment can be percutaneous or open and should be individualized.
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Affiliation(s)
- Jefferson Li
- Department of Orthopaedic Surgery, UCSF Fresno, Fresno, CA, USA
| | | | - Nathan Hoekzema
- Department of Orthopaedic Surgery, UCSF Fresno, Fresno, CA, USA
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Langdell HC, Zhang GX, Pidgeon TS, Ruch DS, Klifto CS, Mithani SK. Management of Complex Hand and Wrist Ligament Injuries. Hand Clin 2023; 39:367-377. [PMID: 37453764 DOI: 10.1016/j.hcl.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Ligamentous injuries in the hand and wrist are often underdiagnosed and can present with significant functional limitations if there is untimely recognition of injury. Adequate repair or reconstruction is critical in restoring joint stability and mobility. The purpose of this review is to provide an overview of the metacarpophalangeal joint, scapholunate interosseous ligament (SLIL), and non-SLIL carpal ligament anatomy, diagnosis, imaging, treatment consideration and options, as well as surgical techniques encompassing repair, reconstruction, and fusion.
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Affiliation(s)
- Hannah C Langdell
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA
| | - Gloria X Zhang
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tyler S Pidgeon
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - David S Ruch
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Suhail K Mithani
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA; Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA.
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Holderread BM, Jafarnia J, Phelps B, Perrin M, Jack RA, Harris JD, Liberman SR. Return to Sport and Performance After Thumb Metacarpophalangeal Joint Collateral Ligament Surgery in the National Basketball Association. Cureus 2023; 15:e42499. [PMID: 37637654 PMCID: PMC10456974 DOI: 10.7759/cureus.42499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Basketball players are at increased risk of thumb collateral ligament injury (ulnar collateral ligament (UCL) and radial collateral ligament (RCL)). Methods The National Basketball Association (NBA) players with thumb collateral ligament surgery were identified using publicly available data. Performance statistics, ligament injuries (UCL or RCL), return to sport (RTS) time, laterality, and injury dates were recorded. Cases were matched 1:1 with controls based on age (±1 year), body mass index (BMI), NBA experience (±1 year), and performance statistics prior to the index date. RTS was defined as playing in one NBA game postoperatively. Career longevity was evaluated. Summary statistics were calculated, and Student's t-tests (ɑ = 0.001) were performed. Results All 47 players identified with thumb collateral ligament surgeries returned to sport. Thirty-three players (age: 26.9 ± 3.0) had one year of postoperative NBA experience for performance analysis. Career length (case: 9.6 ± 4.1, control: 9.4 ± 4.3, p > 0.001) was not significantly different from controls (p > 0.001). The same season time to RTS (n = 20) was 7.1 ± 2.4 weeks. Off-season or season-ending surgery (n = 13) RTS time was 28.4 ± 18.7 weeks. Neither thumb collateral ligament (UCL, n = 7; RCL, n = 10; unknown, n = 16) had an identifiable difference between the groups when evaluating career length. Career length, games/season, and performance were not different for players who underwent surgery on their dominant thumb (63.6%, 21/33) compared to controls (p > 0.001). Conclusion RTS rate is high in NBA athletes undergoing thumb collateral ligament surgery. Players do not experience decreased performance or career length due to thumb collateral ligament surgery, regardless of a dominant or non-dominant thumb injury.
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Affiliation(s)
| | - Jordan Jafarnia
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Brian Phelps
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Mark Perrin
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Robert A Jack
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Joshua D Harris
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Shari R Liberman
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
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Schmidt GJ, Crosby NE, Merrell GA. Use of an Abductor Pollicis Brevis Tendon Slip for Reconstruction of the Radial Collateral Ligament of the Thumb Metacarpophalangeal Joint: An Anatomical Investigation. Hand (N Y) 2023; 18:469-472. [PMID: 34420374 PMCID: PMC10152521 DOI: 10.1177/15589447211038713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reconstruction of the radial collateral ligament (RCL) of the thumb metacarpophalangeal (MP) joint is commonly performed for chronic injuries. This study aims to evaluate the anatomical feasibility and reliability of using the abductor pollicis brevis (APB) tendon to reconstruct the RCL. METHODS Ten cadaver arms were dissected to evaluate the relationship between insertions of the RCL and APB. A slip of the APB was divided from tendon and reflected proximally. The dissected tendon was deemed sufficient for reconstruction if it could be reflected to the footprint of the RCL origin. The size of the dissected APB slip was then compared with that of the RCL. RESULTS The dissected slip of the APB could be fully reflected proximally to the RCL origin in all specimens. The APB insertion was also found to be closely approximated to the RCL insertion, averaging 2.1 mm distal and 1.8 mm dorsal. Significant differences existed between the lengths (P < .001) of the APB slip and RCL, with no significant difference in widths (P = .051). CONCLUSIONS A sufficient APB tendon slip can be obtained to reliably reconstruct the RCL of the thumb MP. The location of the APB insertion closely approximates the RCL insertion.
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Allahabadi S, Kwong JW, Pandya NK, Shin SS, Immerman I, Lee NH. Return to Play After Thumb Ulnar Collateral Ligament Injuries Managed Surgically in Athletes—A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Mitchell TW, Mitchell SA, Wu C. Radial Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint. Curr Rev Musculoskelet Med 2022; 15:581-589. [PMID: 36303098 PMCID: PMC9789250 DOI: 10.1007/s12178-022-09805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Injuries to the radial collateral ligament (RCL) of the thumb are thought to be relatively uncommon, especially when compared to the ulnar collateral ligament. However, the radial collateral ligament is increasingly recognized as critical for the overall stability of the thumb metacarpophalangeal joint. This article sets out to provide a comprehensive review of RCL injuries of the thumb MCP joint, including epidemiology, biomechanics, diagnosis, and treatment. RECENT FINDINGS Although traditionally thought to respond well to conservative management, especially when compared to injuries to the ulnar collateral ligament, there is mounting evidence that chronic RCL injury leads to thumb metacarpophalangeal joint instability and can accelerate post-traumatic joint degeneration. Thus, much of the recent literature details surgical treatment options for radial collateral ligament injury, including repair and reconstruction. While incomplete tears of the thumb RCL respond well to immobilization, complete tears should generally be treated with operative management, either direct repair or anatomic reconstruction, depending on tissue quality. Even subacute and chronic injuries may be amenable to direct repair, with good to excellent outcomes, including in high-demand patient populations, such as professional athletes.
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Affiliation(s)
- Thomas W. Mitchell
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge St Suite 10A, Houston, TX 77030 USA
| | - Scott A. Mitchell
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge St Suite 10A, Houston, TX 77030 USA
| | - Chia Wu
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge St Suite 10A, Houston, TX 77030 USA
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Morales-Restrepo A, Bhogal S, Fowler JR. Rupture Site Location of Surgically Treated Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligaments. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:278-281. [PMID: 35415577 PMCID: PMC8991751 DOI: 10.1016/j.jhsg.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/19/2021] [Indexed: 10/27/2022] Open
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George S, Rizkallah M, Leviet D, Leclercq C, El Abiad R. Early vs late surgical treatment of radial instability of the thumb metacarpophalangeal joint. A retrospective cohort study. HAND SURGERY & REHABILITATION 2021; 40:771-776. [PMID: 34455102 DOI: 10.1016/j.hansur.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/14/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
There is no clear evidence in the literature whether treating thumb radial collateral ligament (RCL) injury in the acute phase improves outcome. The purpose of the present study was to compare the clinical and radiological results of RCL repair in acute and chronic settings. Fourteen patients were included. Clinical range of motion (ROM) of the thumb, Kapandji score and radiological parameters were compared pre- and post-operatively to the contralateral uninjured thumb (control group) to evaluate the results of the surgical technique. Patients were then divided into two groups according to early versus late repair and outcomes were compared between the two groups and the control group. Preoperatively, mean spontaneous angle between first metacarpal (M1) and proximal phalanx (P1) (spontaneous M1P1 angle), ulnar stress M1P1 angle, ROM and Kapandji score differed significantly between injured and uninjured sides. Postoperatively these parameters for the injured side improved, reaching values similar to those on the uninjured side, especially with acute phase treatment; late treatment also tended to provide clinical improvement in ROM, Kapandji score and ulnar stress angle, but with significant improvement only for spontaneous deviation of the thumb. This study showed the late and immediate repair of the RCL of the thumb both gave good results, with slightly better outcome with acute phase repair. LEVEL OF EVIDENCE: Therapeutic, Level III.
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Affiliation(s)
- S George
- Saint Joseph University, Faculty of Medicine, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
| | - M Rizkallah
- Saint Joseph University, Faculty of Medicine, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
| | - D Leviet
- Hôpital de la Croix Rouge Henry Dunant, 95 Rue Michel Ange, 75016 Paris, France.
| | - C Leclercq
- Institut de la Main, Clinique Bizet, 21 Rue Georges Bizet, 75016 Paris, France.
| | - R El Abiad
- Saint Joseph University, Faculty of Medicine, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
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Carneiro BC, Araújo FF, Guimarães JB, Chemin RN, Jorge RB, Filho AGO, Nico MAC. Stener-like lesions in the hand, knee and foot: a review of anatomy, mechanism of injury and imaging evaluation. Clin Imaging 2021; 76:235-246. [PMID: 33975225 DOI: 10.1016/j.clinimag.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/14/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
A Stener lesion is a displaced tear of the ulnar collateral ligament in the metacarpophalangeal joint of the thumb in which the adductor pollicis aponeurosis is positioned between the retracted ligament and the injury site, preventing natural healing. This lesion was first described in 1962, and since then, both radiologists and orthopedists have considered it important to treat surgically. Although this lesion was originally described in the thumb, this injury mechanism can occur in other joints of the hand, knee, and foot. The purpose of this study was to review the relevant aspects of classic Stener lesions of the thumb, as well as other Stener-like lesions, including their anatomy, mechanisms of lesion formation and imaging features. The Stener-like injury pattern often necessitates surgical repair or reconstruction; thus, it is essential that radiologists recognize and report the different patterns of injury.
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Affiliation(s)
- Bruno Cerretti Carneiro
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Flávia Ferreira Araújo
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Renan Nogueira Chemin
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Rafael Baches Jorge
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Alípio Gomes Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Marcelo Astolfi Caetano Nico
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
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Haug VFM, Diehm YF, Pfeiler P, Kotsougiani-Fischer D, Bickert B, Kneser U, Hirche C, Fischer S. Radial collateral ligament repair of the thumb: long-term outcomes and predictive factors of postoperative deficits. Arch Orthop Trauma Surg 2020; 140:1293-1299. [PMID: 32500203 DOI: 10.1007/s00402-020-03509-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The thumb's radial collateral ligament (RCL) plays an important role in stabilizing the first metacarpophalangeal joint (MCP-1). RCL injuries are rare and treatment recommendations are inconsistent in the current literature. The aim of this study was to report on long-term outcomes following surgical repair of thumb RCL tear and to identify prognostic risk factors for treatment failure. METHODS Patients with RCL tear from 10/1998 to 10/2019 were included in the present retrospective single center cohort study. In follow-up visits, participants were assessed regarding pain, range of motion and strength as well as with disability of shoulder, arm and hands (DASH), and the Short-Form 36 (SF36) questionnaires. Finally, predictive factors of postoperative deficits were identified. RESULTS 43 patients fulfilled inclusion criteria. Median age was 43.5 years (range 18-80 years). The most frequent mechanism of injury was a fall or impact. Bony avulsions were identified in 46.5% (20/43). Time from injury to surgery was 12 days (0-276 days). One Stener-like lesion was observed intraoperatively among our patients. After surgical repair, the MCP-1 joint was stable in every patient. Mean time to follow-up was 5.3 years (1 month to 17 years). Persistency of pain in the MCP-1 joint was reported by 11 patients. Postoperative averaged score was 3.75 on DASH and 44.96 on SF36, respectively. The average grip and pinch strength was 32.7 kg and 8.37 kg, respectively. Predictive factors of postoperative deficits were delay of surgery of > 3 weeks (OR 10.72, p 0.017) and palmar subluxation prior to surgery (OR 8.86, p 0.019). CONCLUSION Long-term follow-up has proven that surgical repair of RCL enables the patient to regain adequate stability and strength of the MCP-1 joint and minimizes disability. Predictive risk factors of pain persistency after surgery are surgical delay and palmar subluxation of the MCP-1 joint.
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Affiliation(s)
- Valentin F M Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.,Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yannick F Diehm
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.,Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Pfeiler
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.,Department of Plastic, Reconstructive and Aesthetic Surgery, ISAR Klinikum, Munich, Germany
| | - Dimitra Kotsougiani-Fischer
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Berthold Bickert
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Christoph Hirche
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sebastian Fischer
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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Daley D, Geary M, Gaston RG. Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries. Clin Sports Med 2020; 39:443-455. [DOI: 10.1016/j.csm.2019.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Reconstruction of chronic thumb metacarpophalangeal radial collateral ligament injuries with free tendon grafts. Jt Dis Relat Surg 2020; 31:62-7. [PMID: 32160496 PMCID: PMC7489123 DOI: 10.5606/ehc.2020.70796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to review our reconstruction method to treat chronic grade 3 thumb metacarpophalangeal (MP) joint radial collateral ligament (RCL) tears using free tendon grafts. Patients and methods
Thirteen male patients (mean age 41 years; range, 20 to 67 years) who received a free tendon graft to treat chronic grade 3 thumb MP joint RCL injury between May 2016 and July 2018 were evaluated prospectively. Patients with incomplete bone maturation (n=1), those who had additional injuries in the same extremity (n=1), and those who had previously undergone surgery on the same extremity (n=1) were excluded. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used for functional evaluation and the visual analog scale (VAS) was also used for pain evaluation. Results
The decrease in DASH (p=0.008) and VAS (p=0.03) scores and the increase in grip (p=0.031) and pinch strength (p=0.006) between the preoperative and final follow-up values were statistically significant. No ulnar deviation was observed in X-rays at the final examination, nor was MP joint radial instability observed under ulnar stress during clinical examinations. In two patients, 1 and 1.5 mm palmar subluxation was observed at final examination. The other 11 patients had no palmar subluxation at final examination. Conclusion Although ours is a more complicated method compared to other reconstruction approaches, we think that it is a suitable alternative for achieving joint stability and good functional results.
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Jakubietz RG, Erguen S, Bernuth S, Meffert RH, Gilbert F, Jakubietz M. An anatomical study on the Stener-type lesion of the radial collateral ligament of the metacarpophalangeal joint of the thumb. J Hand Surg Eur Vol 2020; 45:131-135. [PMID: 31739733 DOI: 10.1177/1753193419887344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Stener-type lesion of the radial collateral ligament is rare. The insertion of the abductor pollicis brevis is believed to preclude its occurrence. The aim of this study was to determine whether this lesion can be induced mechanically. Four specimens were tested in neutral rotation and 20° of supination, in 45° and 30° of flexion, and in the neutral position. The angle of ulnar adduction to form a Stener-type lesion was measured. The lesion occurred only in 45° flexion in all specimens. A lesser angle of flexion decreased the rate of ligament displacement. In the neutral position no ligament displacement was found. A Stener-type lesion of the radial collateral ligament can occur in ulnar adduction and flexion of the metacarpophalangeal joint. Supination of the joint increases the likelihood of ligament displacement. As distal ruptures of the radial collateral ligament are uncommon, a high index of suspicion is required for diagnosis.
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Affiliation(s)
- Rafael G Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Sueleyman Erguen
- Institute for Anatomy and Cellbiology, University Wuerzburg, Wuerzburg, Germany
| | - Silvia Bernuth
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Rainer H Meffert
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Fabian Gilbert
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
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17
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Weintraub MD, Hansford BG, Stilwill SE, Allen H, Leake RL, Hanrahan CJ, Chan BY, Soltanolkotabi M, Kobes P, Mills MK. Avulsion Injuries of the Hand and Wrist. Radiographics 2020; 40:163-180. [DOI: 10.1148/rg.2020190085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael D. Weintraub
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Barry G. Hansford
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Sarah E. Stilwill
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Hailey Allen
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Richard L. Leake
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Christopher J. Hanrahan
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Brian Y. Chan
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Maryam Soltanolkotabi
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Patrick Kobes
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Megan K. Mills
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
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18
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Wang KK, Boyce G, Peters T, Anderson H, Hoy G. Efficacy of Primary Repair in Professional Athletes with Chronic Radial Collateral Ligament Injuries of Thumb Metacarpophalangeal Joint. J Hand Surg Asian Pac Vol 2019; 24:138-143. [PMID: 31035879 DOI: 10.1142/s2424835519500176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Management of grade III injuries of the radial collateral ligament (RCL) of the thumb is controversial. These injuries are often treated with early surgery. However, early surgery may not be practical for the professional athlete. We report on the outcome of delayed primary repair of chronic RCL injuries without the use of tendon grafts or tendon transfers. Methods: Twelve elite professional athletes with 15 soft tissue RCL injuries who underwent delayed surgery (greater than 6 weeks) were included in this study. Athletes were managed with splinting and ongoing play during the sporting season, and underwent surgery at the conclusion of the season. Mean duration from injury to surgery was 5 months. Mean follow-up was 4.2 years after surgery. Patient-report outcome measures including pain, satisfaction rating, and disability of the arm, shoulder and hand (DASH) scores were collected. Examination findings including range of motion, laxity, and grip and pinch strength were also measured. Return-to-play data were collected for all athletes. Results: The RCL was able to be primarily repaired with suture anchors in all cases. All twelve patients were able to return to competitive play at the same pre-injury professional level. Post-operative joint function such as range of motion and laxity were comparable to the unaffected contralateral side, as were grip and lateral pinch strengths. Tip-pinch strength is lower compared to the unaffected side, but is comparable to age and sex-matched reference group. Conclusions: Delayed primary repair of the RCL is a viable option and results in satisfactory long-term outcomes. This option may be more preferable to the professional athlete who wishes to avoid surgery during the sporting season.
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Affiliation(s)
- Kemble K Wang
- * Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia
| | - Glenn Boyce
- * Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia
| | - Tracy Peters
- * Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia
| | - Hamish Anderson
- * Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia
| | - Greg Hoy
- * Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia.,† Department of Orthopaedic Surgery, Austin Hospital, Melbourne, Australia.,‡ Department of Surgery, Monash University, Melbourne, Australia
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19
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Kim BS, Doermann A, McGarry M, Akeda M, Ihn H, Lee TQ. Additional Dorsal Fibrocartilage Repair in a Combined Radial Collateral Ligament and Dorsal Fibrocartilage Injury of the Thumb Metacarpophalangeal Joint. Orthopedics 2019; 42:e268-e272. [PMID: 30763448 DOI: 10.3928/01477447-20190211-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/11/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the necessity of an additional dorsal fibrocartilage (DFC) repair in combined radial collateral ligament (RCL) and DFC injuries of the thumb metacarpophalangeal joint (MPJ). Eight cadaveric thumbs were used. Ulnar/radial deviation, prosupination, and volar/dorsal laxity were measured. Serial sectioning was performed of the RCL and the DFC. The RCL followed by the DFC were then reattached sequentially. Measurements were performed for intact, RCL cut, RCL+DFC cut, RCL repair alone, and RCL+DFC repair. The neutral position shifted ulnarly, pronated, and subluxed volarly after RCL+DFC cut. Volar subluxation was reduced with RCL+DFC repair compared with RCL repair alone. With external loading, ulnar deviation, pronation, and volar laxity increased significantly after RCL+DFC cut. Ulnar deviation reduced significantly with RCL+DFC repair (12.4°, 10.8°, and 10.9°) compared with RCL repair alone (14.4°, 14.3°, and 18.9°) at 0°, 30°, and 60°, respectively. Pronation reduced significantly with RCL+DFC repair (7.1° and 9.4°) compared with RCL repair alone (10.2° and 12.6°) at 0° and 30°, respectively. Volar subluxation reduced significantly with RCL+DFC repair (0.9 mm and 1.2 mm) compared with RCL repair alone (2.1 mm and 1.8 mm) at 30°and 60°, respectively. Radial collateral ligament repair alone does not restore anatomic dorsoradial stability of the thumb MPJ in a combined RCL and DFC injury. Combined repair of the RCL and the DFC is recommended to reduce the MPJ to its native position and minimize postoperative laxity. [Orthopedics. 2019; 42(2):e268-e272.].
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20
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Shin SS, van Eck CF, Uquillas C. Suture Tape Augmentation of the Thumb Ulnar Collateral Ligament Repair: A Biomechanical Study. J Hand Surg Am 2018; 43:868.e1-868.e6. [PMID: 29551339 DOI: 10.1016/j.jhsa.2018.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/21/2017] [Accepted: 02/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to evaluate and compare the biomechanical strength of repair of the thumb ulnar collateral ligament (UCL) alone and repair augmented with suture tape. METHODS Twelve fresh-frozen cadaveric specimens (6 matched pairs) had the UCL divided at its attachment on the base of the proximal phalanx and repaired with or without suture tape augmentation. A material testing machine was used to provide valgus stress at a rate of 0.1 mm/s until failure. The maximum load, load at clinical failure, and mode of failure were recorded. RESULTS In the specimens with UCL repair augmented with suture tape, the maximum load (46.6 N [SD, 25.6 N]) and load at clinical failure (25.3 N [SD, 18.3 N]) were significantly higher than in the repair-only group (8.02 N [SD, 2.24 N]) and (6.00 N [SD, 2.39 N], respectively). CONCLUSIONS In this model, thumb UCL repair with suture tape augmentation demonstrated greater maximum and clinical failure loads compared with nonaugmented repair at time 0, that is, without any biological healing. CLINICAL RELEVANCE Suture tape augmentation of UCL repair may be valuable in the setting of acute tears by decreasing the time of postoperative cast immobilization and, therefore, allowing for earlier thumb metacarpophalangeal joint motion and overall faster clinical recovery.
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21
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Draghi F, Gitto S, Bianchi S. Injuries to the Collateral Ligaments of the Metacarpophalangeal and Interphalangeal Joints: Sonographic Appearance. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2117-2133. [PMID: 29480577 DOI: 10.1002/jum.14575] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/04/2017] [Accepted: 12/09/2017] [Indexed: 06/08/2023]
Abstract
Injuries to the collateral ligaments of the metacarpophalangeal (MCP) and interphalangeal (IP) joints are commonly encountered in both athletes and nonathletes. They require prompt evaluation to ensure proper management and prevent loss of joint motion and permanent disability. Imaging is often required to confirm the diagnosis and assess injury severity. This review article aims to provide physicians with guidelines for sonographic assessment of the collateral ligaments of the MCP and IP and related injuries. Sonographic features of ligament injuries ranging from sprains and partial-thickness tears to full-thickness tears are described. Specific lesions of the ulnar collateral ligament of the thumb MCP joint, such as gamekeeper's thumb, skier's thumb, and Stener lesions, are also included. In conclusion, sonography is effective in evaluating the collateral ligaments of the MCP and IP joints and related injuries and represents a valuable tool for diagnosis.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
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22
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Cates RA, Brault JS, Kakar S. Botox and Thumb MCP Radial Collateral Ligament Reconstruction. J Wrist Surg 2018; 7:156-159. [PMID: 29576922 PMCID: PMC5864494 DOI: 10.1055/s-0037-1604396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
Background We report the use of botulinum toxin to aid in the treatment of chronic radial collateral ligament insufficiency of the thumb. Case Description Treatment included autograft tendon reconstruction and cast immobilization. Six weeks postoperatively, prior to hand therapy, the patient underwent an ultrasound-guided botulinum neurotoxin A injection into the adductor pollicis muscle to negate its deforming forces on the reconstruction. The patient made an excellent recovery and 1 year postoperatively was pain free and had a stable radial collateral ligament (RCL) upon examination. Literature Review The outcomes of RCL repair and reconstruction are unpredictable, in part, due to the strong opposing forces of the adductor pollicis. Clinical Relevance The use of Botox injection may enhance the outcomes of RCL repair or reconstruction by neutralizing the deforming forces of the adductor muscle.
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Affiliation(s)
- Robert A. Cates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey S. Brault
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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23
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Wagner M, Schmoelz W, Stofferin H, Arora R. Biomechanical in vitro comparison of suture anchors for thumb UCL repair. Arch Orthop Trauma Surg 2018; 138:435-442. [PMID: 29353422 DOI: 10.1007/s00402-018-2877-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Indexed: 11/28/2022]
Abstract
Different types of intraosseous suture anchors can be used for thumb ulnar collateral ligament (UCL) repair surgery. Some of them have already been tested biomechanically in intact bone; however, there exists little knowledge of their stability when implanted in avulsion fracture. In this biomechanical in vitro study, three anchor types (hard, soft and novel BoneWelding) were tested on 24 fresh frozen human thumbs from 12 body donors. After the repair of an iatrogenic ligamentous UCL rupture, the thumbs were cyclically loaded. A new set of anchors was implanted at the contralateral radial side of the same specimen into an iatrogenic avulsion fracture and pulled out of the bone. The most common mode of failure in ligamentous UCL repairs was the suture-ligament interface, especially when using soft anchors. In avulsion fractures, the novel anchor withstood significantly higher pullout forces than the hard or soft anchor (65 N vs. 42 N vs. 27 N; p = .006). The BW anchor provides sufficient anchorage in trabecular bone for UCL repair in case of avulsion fractures.
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Affiliation(s)
- M Wagner
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - W Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - H Stofferin
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - R Arora
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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24
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Rozmaryn LM. The Collateral Ligament of the Digits of the Hand: Anatomy, Physiology, Biomechanics, Injury, and Treatment. J Hand Surg Am 2017; 42:904-915. [PMID: 29101974 DOI: 10.1016/j.jhsa.2017.08.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
Ligament injuries are among the most common musculoskeletal injuries seen in clinical practice and ligaments are the most frequently injured structures in a joint. Ligaments play an important role in balancing joint mobility and joint stability. Disruption of joint ligaments severely impairs joint function. Over the past 10 years, a new appreciation of a neuroanatomy and neurophysiology of joint ligaments and its biofeedback loops to surrounding muscles and tendons has emerged to explain the relationship between primary and secondary restraints that allow normal joint motion yet prevent pathological motion. This review focuses on this recent information with a view to new clinical approaches to these common problems.
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Affiliation(s)
- Leo M Rozmaryn
- The Orthopedic Center, The Centers for Advanced Orthopedics, Rockville, MD.
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25
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Abstract
Thumb injuries are common in athletes and present a challenging opportunity for upper extremity physicians. Common injuries include metacarpal base fractures (Bennett and Rolando types), ulnar and radial collateral ligament injuries, dislocation of the carpometacarpal and metacarpophalangeal joints, and phalanx fractures. This review, although not exhaustive, highlights some of the most common thumb injuries in athletes. The treating physician must balance pressure from athletes, parents, coaches, and executives to expedite return to play with the long-term well-being of the athlete. Operative treatment may expedite return to play; however, one must carefully weigh the added risks involved with surgical intervention.
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26
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Abstract
PURPOSE OF REVIEW The purpose of this review is to identify current principles in the diagnosis and treatment of collateral ligament injuries of the thumb in the athlete. RECENT FINDINGS Cadaver studies have clearly identified the ulnar and radial collateral ligaments origin and insertion footprints for repair or reconstruction. Ulnar and radial collateral ligament injuries are common in athletics. History and physical examination are paramount in determining partial versus complete tear. When surgical treatment is indicated, placing the repair/reconstruction in the anatomic footprint restores stability while maintaining motion. The senior author's preferred techniques are reported.
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Affiliation(s)
- Daniel M Avery
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, 4th Floor, New York, NY, 10021, USA
| | - Elizabeth R Inkellis
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, 4th Floor, New York, NY, 10021, USA
| | - Michelle G Carlson
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, 4th Floor, New York, NY, 10021, USA.
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27
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Abstract
Hand injuries account for up to 15% of sports injuries and are common in contact sports and in sports with a high risk of falling. Appropriate management requires knowledge of the type of injury, demands of the sport and position, competitive level of the athlete, future athletic demands and expectations, and the role of rehabilitation and protective splints for return to play. Management of the athlete requires aggressive and expedient diagnostic intervention and treatment. This article describes ligamentous injuries to the thumb, including thumb carpometacarpal dislocations, thumb metacarpophalangeal dislocations, collateral ligament injuries and interphalangeal dislocations, their evaluation, treatment and outcomes.
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Affiliation(s)
- F Patterson Owings
- Department of Orthopaedic Surgery and Biomechanical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 520, Memphis, TN 38104, USA
| | - James H Calandruccio
- Department of Orthopaedic Surgery and Biomechanical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 520, Memphis, TN 38104, USA.
| | - Benjamin M Mauck
- Department of Orthopaedic Surgery and Biomechanical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 520, Memphis, TN 38104, USA
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28
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Wu WC, Wong TC, Yip TH. Chronic Finger Joint Instability Reconstructed With Bone–Ligament–Bone Graft from the Iliac Crest. ACTA ACUST UNITED AC 2016; 29:494-501. [PMID: 15336756 DOI: 10.1016/j.jhsb.2004.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2003] [Accepted: 03/24/2004] [Indexed: 11/25/2022]
Abstract
Five patients with chronic instability of digital joints presented with instability and functional disability. Two patients had ulnar collateral ligament damage of the thumb metacarpophalangeal joint and another had chronic multidirectional instability due to radial collateral ligament, dorsal capsule and palmar plate laxity of the metacarpophalangeal joint of the thumb. The fourth patient had a lax radial collateral ligament and palmar plate of the proximal interphalangeal joint of the little finger and the fifth had chronic laxity of the ulnar collateral ligament of the interphalangeal joint of the thumb. All were reconstructed with bone–ligament–bone graft harvested from the iliac crest. The graft was fixed with screws and joint stability was achieved intra-operatively in all patients. All patients achieved a stable joint with improved functional performance at final followup.
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Affiliation(s)
- W C Wu
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
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29
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Schroeder NS, Goldfarb CA. Thumb Ulnar Collateral and Radial Collateral Ligament Injuries. Clin Sports Med 2015; 34:117-26. [DOI: 10.1016/j.csm.2014.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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30
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Başar H, Başar B, Kaplan T, Erol B, Tetik C. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. ACTA ACUST UNITED AC 2014; 33:384-9. [PMID: 25458468 DOI: 10.1016/j.main.2014.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/23/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
Abstract
This study sought to demonstrate that successful outcomes can be achieved with the new technique presented here for chronic ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal (MCP) joint, as well as with K-wire pinning for acute UCL injury. We followed 19 patients who suffered an UCL rupture (mean follow-up: 14.26±4.65 months) and 32 patients who presented with UCL avulsion fracture (mean follow-up: 16.81±7.54 months). We used a free tendon graft for UCL reconstruction in the UCL rupture group. Both ends of the graft were stabilized with bioabsorbable suture anchors, which were used as biotenodesis interference screws. Closed reduction and K-wire fixation was used in UCL avulsion fracture group. There were no statistically significant differences between operated and contralateral healthy thumb MCP joint in both groups in the grip strength, tip pinch strength, flexion, extension, ulnar deviation, and radial deviation movements at final follow-up. Grip strength, tip pinch strength, ulnar deviation and radial deviation were significantly better in the avulsion group than the rupture group. All patients regained full stability at the MCP joint in avulsion group; 16 patients regained full stability and 3 patients presented with mild laxity (less than 10° laxity) in rupture group. Glickel grading scale used as a functional score was excellent for 30 patients and good for 2 patients in avulsion group; it was excellent for 17 patients and good for 2 patients in rupture group. Our study shows that closed reduction and percutaneous K-wire fixation of acute displaced large UCL avulsion fracture is a simple technique and achieves adequate stability of UCL. For UCL rupture, free tendon reconstruction with bioabsorbable suture anchors provides adequate stability and stable fixation within the tunnels.
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Affiliation(s)
- H Başar
- Department of orthopedics and traumatology, Sakarya training and research hospital, Sakarya, Turkey.
| | - B Başar
- Department of physical medicine and rehabilitation, Akyazı state hospital, Sakarya, Turkey
| | - T Kaplan
- Department of orthopedics and traumatology, Sakarya training and research hospital, Sakarya, Turkey
| | - B Erol
- Department of orthopedic surgery, Marmara university school of medicine, Istanbul, Turkey
| | - C Tetik
- Department of orthopedics and traumatology, Acibadem Maslak hospital, Istanbul, Turkey
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31
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Iba K, Wada T, Hiraiwa T, Kanaya K, Oki G, Yamashita T. Reconstruction of chronic thumb metacarpophalangeal joint radial collateral ligament injuries with a half-slip of the abductor pollicis brevis tendon. J Hand Surg Am 2013; 38:1945-50. [PMID: 23928013 DOI: 10.1016/j.jhsa.2013.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 06/14/2013] [Accepted: 06/14/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate a reconstructive method for chronic radial collateral ligament (RCL) injuries of the thumb metacarpophalangeal (MCP) joint using a combination of RCL advancement and the transfer of a half-slip of the abductor pollicis brevis tendon. METHODS Eight patients (4 male and 4 female; mean age, 25 y) with chronic RCL injury of the thumb MCP joint were enrolled. All patients were referred to our institution because of continuing pain and instability on the radial side of the MCP joint when grasping or pinching objects. The mechanism of the injury was adduction stress to the thumb during sporting activities in 5 patients, a heavy object falling on the thumb in 1, and a fall in 2. The mean duration from RCL injury to surgery was 20 weeks. The average postoperative follow-up was 51 months. We evaluated postoperative outcomes including pain, range of motion of the thumb MCP joint, grip strength, key pinch strength, Disabilities of the Arm, Shoulder, and Hand score, and ability to return to preinjury work or sporting activities. RESULTS No patients demonstrated continuing symptoms, and the MCP joint was stable after surgery. Postoperative grip and pinch strength (37 and 6.3 kg, respectively) were increased compared with preoperative values (34 and 3.9 kg, respectively). All patients returned fully to their preinjury work or sporting activities within 6 months after surgery. Although postoperative flexion was decreased by an average of 6°, no patients noted functional deficiency. CONCLUSIONS We recommend the reconstructive method of RCL advancement and transfer of a half-slip of the abductor pollicis brevis tendon to alleviate pain and improve grip and pinch strength in chronic RCL injuries of the thumb MCP joint.
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Affiliation(s)
- Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
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Köttstorfer J, Hofbauer M, Krusche-Mandl I, Kaiser G, Erhart J, Platzer P. Avulsion fracture and complete rupture of the thumb radial collateral ligament. Arch Orthop Trauma Surg 2013; 133:583-8. [PMID: 23430014 DOI: 10.1007/s00402-013-1701-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE Acute grade III tears of the radial collateral ligament (RCL) of the thumb as well as certain bony avulsion fractures receive early surgical repair at our institution. The aim of this study was to evaluate if patients would benefit from this treatment algorithm at long-term. METHODS 47 patients with RCL bony avulsion fracture or grade III RCL tear were evaluated at a median follow-up of 4.5 years (range 1-17.3 years). Grade III RCL tears were treated operatively when presenting >30° angulation in stress X-ray together with palmar subluxation of ≥3 mm. Further, avulsed bony fragments with diastasis >2 mm or fragment rotation >30°-45° in conventional X-ray underwent surgery. 6 patients with grade III RCL tear as well as 9 patients with bony avulsion underwent surgical repair. RESULTS At follow-up, metacarpophalangeal joint stability and pain free ROM did not differ significantly between the groups. Subjective satisfaction based on the Catalano grading system revealed excellent results in operatively and conservatively treated patients. CONCLUSIONS This retrospective analysis indicates that early surgical repair in severe RCL injuries is associated with unrestricted ROM, persistent joint stability, and subjective patient satisfaction. This data suggest that surgical treatment in certain RCL injuries might be a feasible therapeutic option in order to avoid chronic instability.
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Affiliation(s)
- J Köttstorfer
- Department of Trauma Surgery, General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
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Taylor KF, Lanzi JT, Cage JM, Drake ML. Radial collateral ligament injuries of the thumb metacarpophalangeal joint: epidemiology in a military population. J Hand Surg Am 2013; 38:532-6. [PMID: 23375785 DOI: 10.1016/j.jhsa.2012.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/30/2012] [Accepted: 12/01/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The reasons for variation in the reported incidence rates between thumb metacarpophalangeal joint radial collateral ligament (RCL) and ulnar collateral ligament (UCL) injuries are unclear. Delay in diagnosis of injury to the RCL leads to greater time of patient disability. The purpose of this study was to define the demographics and presentation of patients with RCL injuries in a military health care system. METHODS We performed a retrospective review of electronic medical records over a 5-year period to determine the incidence and epidemiology related to patients with instability of the thumb metacarpophalangeal joint resulting from injury of the radial or ulnar collateral ligaments. RESULTS A total of 56 patients presented with thumb metacarpophalangeal joint instability. Of these, 18 (32%) had an RCL injury. Patients with an RCL injury were, on average, younger than those with UCL injuries. Those with RCL injuries were more likely to require surgery than were those with UCL injuries (67% vs 40%). With regard to time to presentation, most patients with UCL injuries presented 2 to 10 weeks after injury, whereas nearly all patients with RCL injuries presented greater than 10 weeks after injury. Radial collateral ligament injuries were more likely than UCL injuries to have resulted from an axial load (56% vs 16%), whereas UCL injuries were more likely to have been caused by an abduction-adduction moment (50% vs 22%). CONCLUSIONS In this series, patients sustaining injuries to the RCL were younger and presented later than their counterparts with UCL instability. Close attention to subtle or frank instability presenting as pain in younger patients with axial loading injury mechanisms may allow early diagnosis and appropriate treatment of this injury.
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Affiliation(s)
- Kenneth F Taylor
- Orthopaedic Surgery Service, Tripler Army Medical Center, Honolulu, HI, USA.
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Abstract
PURPOSE This study biomechanically evaluated a technically easy variation of anatomical reconstruction of the thumb metacarpophalangeal (MCP) joint ulnar (UCL) and radial (RCL) collateral ligaments. Based on previous work describing the anatomical origin and insertion of these ligaments, we hypothesized that, using these attachment points, joint stability would be restored without significant loss of MCP flexion. METHODS The collateral ligaments were isolated in 30 cadaveric thumbs (15 UCLs and 15 RCLs). A cyclical load was applied to the MCP joint to assess flexion, radial/ulnar deviation in neutral, and radial/ulnar deviation in 30° of flexion. The collateral ligaments were detached from the bone while their origin and insertion points were marked. Using these sites, anatomical ligament reconstruction was performed with a palmaris longus tendon graft and interference screw fixation. Cyclical testing was repeated on the reconstructed ligaments. RESULTS No significant difference was found between intact and reconstructed UCLs when tested for radial deviation in neutral, radial deviation in 30° of flexion, or total MCP flexion. No significant difference was found between intact and reconstructed RCLs when tested for ulnar deviation in neutral, ulnar deviation in 30° of flexion, or total MCP flexion. CONCLUSIONS Our anatomical reconstruction is simple and restores UCL and RCL anatomy as compared with current techniques in the literature by placing the origin and insertion at their anatomical points with use of an interference screw. Using these anatomical origins and insertions, we were able to restore the MCP flexion and stability seen in an intact ligament. CLINICAL RELEVANCE Our anatomical reconstruction offers a technically easy option for reconstruction of thumb MCP collateral ligament injuries, restoring joint stability without sacrificing flexion.
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Abstract
The thumb collateral ligaments at the metacarpophalangeal joint are important to the elite athlete for precision grip and pinch. Injuries to these ligaments can result in pain and instability and are seen at a higher frequency at the elite level. Whereas the collateral ligament tears used to be associated primarily with recreational skier's injury, these injuries have been reported with increasing frequency in major professional sports. The ulnar collateral and radial collateral ligament injuries of the thumb occur through different mechanisms and are described in separate sections given the differences in their anatomy.
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Affiliation(s)
- Arthur T Lee
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Martínez-Villén G, Pérez García J, Pérez Barrero P, Herrera A. Thumb metacarpophalangeal joint ligament reconstruction with a triangular tendon graft in posttraumatic chronic instability. ACTA ACUST UNITED AC 2012; 31:1-6. [DOI: 10.1016/j.main.2012.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 12/08/2011] [Accepted: 01/15/2012] [Indexed: 11/15/2022]
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Abstract
The ulnar and radial collateral ligaments are primary stabilizers of the thumb metacarpophalangeal (MP) joint. Injury to these ligaments can lead to instability and disability. Stress testing is essential to establish the diagnosis. Complete tear is diagnosed on physical examination when the proximal phalanx of the thumb can be angulated ulnarly or radially on the metacarpal head by 30° to 35° with the MP joint in either zero degrees of extension or 30° of flexion. Lack of a firm end point or angulation measuring >15° on stress testing compared with the contralateral thumb MP joint are also indicative of complete tear. Partial ligament injuries may be managed nonsurgically, but complete tears are usually managed surgically. Various techniques are used to reattach the ligament to bone, including suture anchors and, less commonly, repair of midsubstance tears. Options for managing chronic injuries include ligament repair, ligament reconstruction with a free tendon graft, and arthrodesis of the MP joint.
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Abstract
The original Stener lesion, described in 1962, refers to an ulnar collateral ligament tear of the thumb metacarpophalangeal joint with adductor aponeurosis interposition. The adductor aponeurosis serves as a mechanical block to healing by preventing apposition of the torn ends of the ulnar collateral ligament. This article presents a case of a 27-year-old woman with painful swelling of the thumb metacarpophalangeal joint following a car accident. Complete tear of the radial collateral ligament was diagnosed based on physical and radiographic examinations. Radial collateral ligament injuries are reported to be less common than ulnar collateral ligament injuries, and, in the past, radial collateral ligament tears were thought to be innocuous, requiring little intervention. More recently, the significance of these injuries has been well documented, and there is support for acute surgical management of complete radial collateral ligament tears. During surgical intervention in our case, we found an intrasubstance tear of the radial collateral ligament with the proximal portion of the ligament retracted and lying superficial to the abductor aponeurosis, thereby producing a Stener-like lesion on the radial side of the joint. The incidence of a Stener-like lesion to the radial collateral ligament is unknown, but it has only been reported once in the literature. Although a primary radial collateral ligament tear may heal by soft tissue apposition, we felt that conservative management in our patient would unlikely lead to healing due to interposition of the abductor aponeurosis. This case supports current recommendations for surgical intervention of complete radial collateral ligament injuries due to the possibility of a Stener-like lesion with soft tissue interposition recurring in the future.
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Affiliation(s)
- Jesse F Doty
- University of Tennessee College of Medicine, Chattanooga, Tennessee, USA
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Patel S, Potty A, Taylor EJ, Sorene ED. Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm. Strategies Trauma Limb Reconstr 2010; 5:1-10. [PMID: 20360873 PMCID: PMC2839319 DOI: 10.1007/s11751-010-0079-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 01/15/2010] [Indexed: 11/21/2022] Open
Abstract
The management of injury to the ulnar and radial collateral ligaments at the metacarpophalangeal joint of the thumb is complex. Treatment is dependent upon a number of factors with a wide variety of options for each ligament. Inadequate treatment has the potential to lead to a poor functional outcome. We present the relevant clinical anatomy, mechanism of injury, methods of treatment available and suggest a single treatment algorithm for use in the management of these injuries.
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Affiliation(s)
- Shelain Patel
- Department of Trauma and Orthopaedics, University College Hospital, 235 Euston Road, London, NW1 2BU UK
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Locking of the metacarpophalangeal joint of the thumb with the radial collateral ligament rupture after stress radiography. Arch Orthop Trauma Surg 2010; 130:237-9. [PMID: 19609539 DOI: 10.1007/s00402-009-0933-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Indexed: 02/09/2023]
Abstract
Stress test is a commonly used diagnostic examination to evaluate the radial collateral ligament (RCL) tear of the thumb metacarpophalangeal (MCP) joint to indicate the surgical intervention. We experienced a locked MCP joint after stress test in a patient with the RCL and volar plate injury.
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Thumb metacarpophalangeal joint injuries. CURRENT ORTHOPAEDIC PRACTICE 2009. [DOI: 10.1097/bco.0b013e3181a8e560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wong TC, Ip FK, Wu WC. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumb--minimum 5-year follow-up evaluation. J Hand Surg Am 2009; 34:304-8. [PMID: 19181232 DOI: 10.1016/j.jhsa.2008.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 09/27/2008] [Accepted: 10/02/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The present study evaluated prospectively the functional and radiological results of a consecutive series of 7 patients who had bone-periosteum-bone (BPB) grafts harvested from the iliac crest for treatment of chronic ulnar instability of the metacarpophalangeal (MCP) joint of the thumb after a minimum of 60 months. METHODS Seven thumbs from 7 patients were entered into a prospective study for surgical treatment of chronic finger joint instability. Treatment consisted of reconstruction of the ulnar collateral ligament of the MCP joint of the thumb by a BPB graft harvested from the iliac crest. Stability, range of motion, pinch grip, and radiographs were evaluated at least 60 months after surgery. RESULTS All 7 patients had full active range of motion of the treated thumb at the final follow-up evaluation (average, 75 months after surgery). All patients had equal stability and normal pinch grip when comparing with the untreated thumb. The mean time off work was 3 months for 6 patients who were injured at work. At final follow-up evaluation, radiographs showed all grafts incorporated without implant complications, no osteoarthritis changes were noted, and stress radiographs showed that all patients had normal stability in the treated thumb when compared with the untreated thumb. CONCLUSIONS Chronic ulnar instability of the MCP joint of the thumb reconstructed with BPB graft harvested from the iliac crest is an effective and safe method to allow restoration and maintenance of a stable, pain-free thumb. The results of the current study support the long-term durability of this method. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Tak-Chuen Wong
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
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Puhaindran ME, Cheah AEJ, Yong FC. Re: "Stener lesion" after collateral ligament rupture of the proximal interphalangeal joint of the index finger. J Hand Surg Eur Vol 2008; 33:678-9. [PMID: 18977840 DOI: 10.1177/1753193408092036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M. E. Puhaindran
- Department of Hand and Reconstructive Microsurgery, National
University Hospital, 5 Lower Kent Ridge Crescent, Singapore 119074 and the
Department of Hand Surgery, Singapore General Hospital, Singapore
| | - A. E. J. Cheah
- Department of Hand and Reconstructive Microsurgery, National
University Hospital, 5 Lower Kent Ridge Crescent, Singapore 119074 and the
Department of Hand Surgery, Singapore General Hospital, Singapore
| | - F. C. Yong
- Department of Hand and Reconstructive Microsurgery, National
University Hospital, 5 Lower Kent Ridge Crescent, Singapore 119074 and the
Department of Hand Surgery, Singapore General Hospital, Singapore
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Edelstein DM, Kardashian G, Lee SK. Radial collateral ligament injuries of the thumb. J Hand Surg Am 2008; 33:760-70. [PMID: 18590860 DOI: 10.1016/j.jhsa.2008.01.037] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 01/29/2008] [Indexed: 02/02/2023]
Abstract
Radial collateral ligament (RCL) injuries of the thumb are relatively common although they are less common than ulnar collateral ligament injuries, which make up 10% to 42% of collateral ligament injuries of the thumb. The RCL is especially important for pinch movements and for movements of depression. Complete disruption of the RCL can result in both static and dynamic instability, which can lead to a predictable sequence of a painful deformity resulting in articular degeneration. Most authors agree that both acute and chronic grade 3 RCL tears should be surgically treated. There are various methods of repair or reconstruction of the RCL that yield satisfactory results, providing radial stability and intending to preclude the appearance of degenerative disease of the metacarpophalangeal joint. This article reviews the anatomy, physiology, diagnosis, and treatment, including surgical technique, for RCL injuries of the thumb.
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Affiliation(s)
- David M Edelstein
- New York University-Hospital for Joint Diseases, New York, NY 10003, USA
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Horch RE, Dragu A, Polykandriotis E, Kneser U. Radial Collateral Ligament Repair of the Thumb Metacarpophalangeal Joint Using the Abductor Pollicis Brevis Tendon. Plast Reconstr Surg 2006; 117:491-6. [PMID: 16462331 DOI: 10.1097/01.prs.0000197219.77994.b2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Injuries to the radial collateral ligament of the thumb metacarpophalangeal joint are less common than injuries to the ulnar side. Therefore, published data on this subject are scarce. An innovative method of radial collateral ligament repair is hereby presented, placing emphasis on the long-term results. This technically simple method was developed to allow for a biological joint stabilization based on functional and anatomical considerations. The key concept is to reestablish joint stability by spanning the tendinous portion of the insertion of the abductor pollicis brevis over the radial side of the metacarpophalangeal joint. METHODS Nine patients with rupture of the radial collateral ligament were treated by means of the abductor pollicis brevis-plasty. All patients suffered from subacute or chronic radial ligament insufficiency. To determine the subjective results of the repair, a score was developed grading the patient's ranking of the results achieved by the abductor pollicis brevis-plasty. All patients graded the results on a scale from 1 (excellent) to 6 (unacceptable). RESULTS Patients were operated on 37.1 +/- 14.6 days after trauma. Long-term examination was performed after 39 +/- 14.5 months. The patients showed a high satisfaction score of 1.7 +/- 0.5, with good mobility of the metacarpophalangeal I joint (range of motion, 52.2 +/- 6.7 degrees). CONCLUSION Favorable results suggest that the abductor pollicis brevis-plasty is a suitable, safe, and technically feasible procedure for the operative treatment of chronic instability of the thumb metacarpophalangeal joint after radial hyperadduction trauma and complete rupture or deinsertion of the radial collateral ligament.
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Affiliation(s)
- Raymund E Horch
- Department of Plastic and Hand Surgery, University of Erlangen Medical Center, Erlangen, Germany.
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Catalano LW, Cardon L, Patenaude N, Barron OA, Glickel SZ. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. J Hand Surg Am 2006; 31:68-75. [PMID: 16443107 DOI: 10.1016/j.jhsa.2005.08.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 08/18/2005] [Accepted: 08/18/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE Radial collateral ligament (RCL) injuries of the thumb metacarpophalangeal (MCP) joint are much less common than ulnar collateral ligament injuries. Cast or splint immobilization is recommended for treating grade I and grade II tears; however, there is no consensus for treating grade III (complete) tears of the RCL. The purpose of this study was to assess the results of repair of acute grade III tears of the RCL and evaluate the efficacy of late reconstruction for chronic instability. METHODS From 1986 to 2001 there were 26 patients (16 in the repair group, 10 in the reconstruction group) who were reviewed retrospectively and examined clinically after either repair or reconstruction of the RCL of the thumb. The repair group had surgery at a mean of 2.5 weeks after injury and was evaluated at a mean follow-up time of 4.6 years. The reconstruction group had surgery at a mean of 6.8 months after injury and was evaluated at a mean follow-up time of 5.0 years. RESULTS At an average follow-up of 59 months, there were no statistically significant differences in MCP or interphalangeal joint motion, grip or pinch strength, or MCP joint stability between the 2 groups. Based on a newly developed grading system there were 12 excellent and 3 good results in the repair group and 8 excellent and 2 good results in the reconstruction group. Overall satisfaction was excellent for both groups. CONCLUSIONS We recommend the repair of acute grade III RCL injuries and reconstruction of chronic grade III RCL tears of the thumb MCP joint to prevent the development of a painful unstable thumb and possibly to prevent the development of MCP joint arthritis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Louis W Catalano
- C.V. Starr Hand Surgery Center, New York, NY 10019, USA, and University of Sherbrooke, Montreal, Quebec, Canada.
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