Botox and Thumb MCP Radial Collateral Ligament Reconstruction

Cates, Robert A.; Brault, Jeffrey S.

doi:10.1055/s-0037-1604396

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…Bioprotection with botulinum toxin via intramuscular injection was shown to be effective first in an Achilles tendon model in the rat, such that the muscle was incapable of actively producing enough force to rupture the repaired Achilles tendon. 13 Multiple clinical studies have followed with successful use in zone 2 finger flexor tendon repairs, 12 distal biceps tendon repair, 19 thumb MCP radial collateral ligament reconstruction, 20 with the benefits of decreased stress placed on the repair, and decreasing pain associated with the repair.…”

Section: Discussionmentioning

confidence: 99%

Chemoprotection with botulinum toxin following proximal hamstring-Ischial tuberosity avulsion fracture repair

Shilt

McHorse

Moisiuc

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Introduction: Surgical treatment for avulsion injuries of the proximal hamstrings has gained increasing popularity over the past decade. Despite good outcomes, early failures have been noted and have been attributed to slipping and falling, postoperative muscle spasm, or early mobilization. In a recent review of hamstring repair rehabilitation protocols, it was shown that there is marked variability in post-operative management. Post-operative bracing with limiting knee extension and hip flexion is the standard of care in most early rehabilitation protocols. Braces with limitation of hip flexion and knee locked in 90 0 flexion can be awkward, cumbersome and create fall risk. Chemoprotection has more recently been proposed to be an alternative approach to prevent tendon repair failure and controlled mobilization which has been shown to be superior to complete immobilization. We present the first case series of the use of botulinum toxin for chemo-protection of the proximal hamstring ischial avulsion repair, demonstrating its safety and efficacy. Methods: Retrospective case series at a tertiary children's hospital which included patients <18 years of age who underwent interventional treatment for proximal hamstring avulsion injuries of the ischium utilizing botulinum toxin as a chemoprotective agent. Data collected included demographic data, injury and treatment details, imaging, post-operative rehabilitation and return to activity. Descriptive statistical analysis was conducted. Results: Five male patients with mean age 14 years (12e17) were included in the study. All were sports related non-contact injuries. Radiographs showed displaced avulsion fractures in all 5 patients. All patients had failed conservative management initially; mean time to surgery from initial injury was 34.4 weeks. 4 patients underwent open reduction and internal fixation (ORIF), 1 patient with less displacement had bone marrow aspirate (BMA) injection; all had chemoprotection using botulinum toxin injected in the hamstrings. No patient required hip immobilization or knee immobilization locked to 90 . We elected to use a brace locked at 20 knee flexion in 2/5 patients. All patients underwent supervised physical therapy and achieved symmetric knee range of motion (ROM). Post-operative radiographs confirmed healing of the avulsion fracture in all 5 patients and they all returned to previous level of activity at mean 32 weeks (21e43) from surgery. None of the patients had a hamstring re-injury at mean follow up of 27 months (11e42). Conclusion: Our case series is the first in literature that shows the safety and efficacy of chemoprotection with botulinum toxin for the post-operative management of avulsion injuries of proximal hamstrings, by minimizing the need for cumbersome bracing and allowing controlled motion during physical therapy.

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Section: Discussionmentioning

confidence: 99%

Chemoprotection with botulinum toxin following proximal hamstring-Ischial tuberosity avulsion fracture repair

Shilt

McHorse

Moisiuc

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…In addition, graft contraction and continuation of palmar subluxation may also cause joint stiffness. Cates et al [16] reconstructed chronic RCL rupture with free PL autograft and biotenodesis screw, injected botulinum toxin to adductor pollicis muscle before starting physical therapy to protect RCL reconstruction from deforming force of adductor pollicis and start earlier motion, and reported that botulinum toxin may decrease the period of immobilization.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of chronic thumb metacarpophalangeal radial collateral ligament injuries with free tendon grafts

Kibar

Malkoç

2020

Jt Dis Relat Surg

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Radial collateral ligament (RCL) injuries account for 10-40% of collateral ligament injuries of the thumb metacarpophalangeal (MP) joint. [1] In acute tears, immobilization with plaster or splint is recommended. Complete tears are classified as grade 3 and denote a complete ligament tear with an absence of a solid end point on stress testing. In chronic grade 3 RCL injuries, a dorsoradial prominence occurs in the MP joint, resulting in weakness and pain during activity; the recent literature supports surgical treatment for this type of injury. [2] There are many surgical treatment options for chronic tears, including RCL soft tissue advancement, reconstruction with the abductor pollicis brevis (APB), and free tendon grafts. [3-5] In this study, we aimed to review our reconstruction method to treat chronic grade 3 thumb MP joint RCL tears using free tendon grafts. [6] PATIENTS AND METHODS This study was conducted at Haydarpaşa Numune Training and Research Hospital between May 2016 and July 2018. Adult patients who received a free tendon graft to treat chronic grade 3 thumb MP joint RCL injury were evaluated prospectively. Patients with incomplete bone maturation (n=1), those who had additional injuries in the same extremity (n=1), and 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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Radial Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint

Mitchell

2022

Curr Rev Musculoskelet Med

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Botox and Thumb MCP Radial Collateral Ligament Reconstruction

Cited by 4 publications

References 12 publications

Chemoprotection with botulinum toxin following proximal hamstring-Ischial tuberosity avulsion fracture repair

Chemoprotection with botulinum toxin following proximal hamstring-Ischial tuberosity avulsion fracture repair

Reconstruction of chronic thumb metacarpophalangeal radial collateral ligament injuries with free tendon grafts

Radial Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint

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