Early Active Mobilization Following UCL Repair With Mitek Bone Anchor

Crowley, Timothy P.; Stevenson, Susan; Taghizadeh, Rieka; Addison, Patrick; Milner, R.H.

doi:10.1097/bth.0b013e318284dbd7

Cited by 24 publications

(22 citation statements)

References 3 publications

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“…For instable bony avulsions or complete ruptures in an acute setting, surgical treatment is favoured, as it has yielded excellent results [22, 26]. Bone anchors are currently most commonly used for surgical repair in proximal or distal ligament avulsions, whereas mid-substance tears can also be sutured directly.…”

Section: Introductionmentioning

confidence: 99%

The influence of sex and trauma impact on the rupture site of the ulnar collateral ligament of the thumb

et al. 2017

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Purpose and hypothesisAlthough sex- and gender-specific analyses have been gaining more attention during the last years they have rarely been performed in orthopaedic literature. The primary purpose of this study was to investigate whether for injuries of the UCL the specific location of the rupture is influenced by sex. A secondary study question addressed the sex-independent effect of trauma intensity on the rupture site of the UCL.MethodsThis study is a retrospective analysis of all patients with either a proximal or distal bony avulsion or with a mid-substance tear or ligament avulsion of the UCL treated surgically between 1992 and 2015 at two level-I trauma centres. Trauma mechanisms leading to the UCL injury were classified into the following categories: (1) blunt trauma (i.e., strains), (2) low-velocity injuries (e.g., fall from standing height, assaults), and (3) high-velocity injuries (e.g., sports injuries, motor vehicle accidents). After reviewing the surgical records, patients were divided into three groups, depending upon the ligament rupture site: (1) mid-substance tears, (2) proximal ligament or bony avulsions and (3) distal ligament or bony avulsions. Dependencies between the specific rupture site and the explanatory variables (sex, age, and trauma intensity) were evaluated using χ2 test and logistic regression analysis.ResultsIn total, 1582 patients (1094 males, 488 females) met the inclusion criteria. Mean age was 41 years (range: 9–90 years). Taking into account the effects of sex on trauma intensity (p<0.001) and of trauma intensity on rupture site (p<0.001), mid-substance tears occurred more frequently in women, whereas men were more prone to distal ligament or bony avulsions (p<0.001). In other words, sex and rupture site correlated due to the effects of sex on trauma intensity and of trauma intensity on rupture site, but taking into account those effects there still was a significant effect of sex on rupture site.ConclusionsThe results of this study demonstrate that with regression analysis both sex and trauma intensity allow to predict rupture site in UCL injuries.

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Section: Introductionmentioning

confidence: 99%

The influence of sex and trauma impact on the rupture site of the ulnar collateral ligament of the thumb

et al. 2017

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“…Study characteristics of the included trials including the interventions and comparators are provided in Table 1 . Of the three randomised controlled trials, two assessed the outcomes of different rehabilitation regimes in patients who had been exclusively treated with surgery 13 , 14 . The remaining RCT assessed the outcome in patients managed both surgically and non-surgically, who were randomised to treatment with either a plaster cast or a functional splint 15 .…”

Section: Resultsmentioning

confidence: 99%

Therapeutic interventions for acute complete ruptures of the ulnar collateral ligament of the thumb: a systematic review

et al. 2018

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Background: The aim of this study was to evaluate the effectiveness of interventions for acute complete rupture of the ulnar collateral ligament (UCL) of the thumb in adults. Methods: The following databases were searched: MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO, from database inception to 31 st January 2018. Inclusion criteria were: (i) randomised controlled clinical trials (RCTs) or study of intervention with a comparator; (ii) participants with diagnosis of acute complete rupture of the UCL of the thumb; (iii) participants aged 18 years of age or older at enrolment; and (iv) published in a peer-reviewed English-language journal. Results: In total, six studies were identified for inclusion after screening. All studies had a high risk of bias. Three studies were retrospective comparative case series which compared two different surgical techniques (bone anchor versus pull out suture, suture versus pull out suture, suture versus steel wire). Of these studies, three were RCTs, two of which compared different rehabilitation regimes in patients managed surgically (plaster versus early mobilization, new spica versus standard spica). The remaining RCT compared two different rehabilitation regimes in a mixed group of surgically/non-surgically treated patients. The RCT comparing a standard spica with a new spica demonstrated a statistically significant improvement in outcomes with the new spica at all time points (range of motion, Dreiser index and VAS); this was also the only study to provide sufficient outcome data for further analysis. Conclusion: There is no prospective evidence comparing surgery to non-operative treatment for acute complete ruptures of the ulnar collateral ligament of the thumb. There is weak evidence to suggest that early mobilisation may be beneficial following surgical repair. Further research is necessary to better define which patients benefit from which specific interventions.

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“…53 Suture anchors provide predictable and reliable fixation with the ability to allow active range of motion early in the rehabilitation period. 55,56 Complications are few and include failure of primary repair, infection, paresthesias on the radial border of the thumb, and decreased range of motion. 2,14,23,53,57 CHRONIC ULNAR COLLATERAL LIGAMENT RECONSTRUCTION Injuries greater than 3 weeks old have historically had poor outcomes with surgical repair, presumably because of attenuation of the remnant ligament.…”

Section: Acute Ulnar Collateral Ligament Repairmentioning

confidence: 98%

“…Recent evidence has shown that early active range of motion is safe following suture anchor fixation. 56,67 In this protocol, the forearm-based thumb spica splint is removed at postoperative day 3 to 5 and is replaced by a removable thermoplastic splint. Patients are instructed to come out of the splint 4 times per day for active range of motion exercises.…”

Section: Postoperative Managementmentioning

confidence: 99%