Combined Reconstruction of Volar and Radial Instability of a Thumb Metacarpo-Phalangeal Joint

Abstract

The purpose of this paper is to present a case of the combined volar and radial ligament instability of a thumb metacarpophalangeal joint secondary to trauma. A successful reconstruction of the volar capsule and the radial collateral ligament was achieved using the tendon of the extensor pollicis brevis.

Radial Collateral Ligament Injuries of the Thumb

“…Chronic injuries may be treated with direct repair, 3,10,11,12 RCL soft tissue advancement, 1,10,11 RCL soft tissue imbrication, 1,10,11 RCL advancement with APB or other soft tissue overlap, 2,3,10,11,21 or RCL tendon graft reconstruction. 1,3,7,11,21,22 All these options fall into 1 of 2 types of ligament reconstruction: (1) free tendon grafts or (2) local tissue reconstruction. Advantages of free tendon grafts are limited donor site morbidity and flexibility in positioning the graft.…”

Radial Collateral Ligament Repair of the Thumb Metacarpophalangeal Joint Using the Abductor Pollicis Brevis Tendon

“…6 Hocker and Pachucki demonstrated in a follow-up study of 155 patients with collateral ligament injuries of the thumb that 40 percent of the patients with conservative treatment developed severe instability of the joint. In the group of patients that were treated operatively, instability occurred in every 10th case.…”

“…5,6,8,13,14 In general, there are two different types of radial collateral ligament repair operations: repair using free tendon grafts and repair using local muscles or tendons. The presented abductor pollicis brevis-plasty belongs to the latter category.…”

“…5 The tendon of the extensor pollicis brevis has been used by Brewood et al for reconstruction of the volar capsule and the radial collateral ligament. 6 Repair of the radial collateral ligament at the site of injury in combination with distal advancement of the abductor pollicis brevis tendon provided functional and clinical stability in a series of nine patients. 7 Soft-tissue sleeve advancement and bony reattachment have been successfully applied by Coyle for treatment of acute, chronic, and late radial collateral ligament instabilities.…”

Traitement d'une instabilité post-traumatique en hyperextension de l'articulation métacarpophalangienne du pouce par greffe tendineuse libre et fixation par ancres

“…En effet, dans une série de 70 entorses graves de la MCP du pouce, Breek retrouve quatre atteintes combinées [4]. Une réparation des structures collatérales et palmaires semble nécessaire pour obtenir une stabilité suffisante selon Breek et al [4] et Brewood et Menon [5].…”