Ligament replacement for chronic instability of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb

Glickel, Steven Z.; Malerich, Matthew M.; Pearce, S; Littler, J. William

doi:10.1016/0363-5023(93)90068-e

Cited by 111 publications

(89 citation statements)

References 8 publications

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“…Implant positioning can be adjusted to improve the stability of the TMC prosthesis and prevent dorsal dislocation: on the trapezium side, the cup can be placed more vertically to increase the coverage of the trapezial sphere; on the metacarpal side, an angled neck can be used to center the trapeziometacarpal joint. In cases of frontal instability, options are retensioning of the soft tissues, reattaching the ulnar collateral ligament or performing a Littler ligament reconstruction [22].…”

Section: Dislocation and Instabilitymentioning

confidence: 99%

Complications and failures of the trapeziometacarpal Maia® prosthesis: A series of 156 cases

Bricout

Rezzouk

2016

Hand Surgery and Rehabilitation

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Section: Dislocation and Instabilitymentioning

confidence: 99%

Complications and failures of the trapeziometacarpal Maia® prosthesis: A series of 156 cases

Bricout

Rezzouk

2016

Hand Surgery and Rehabilitation

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“…The need for interposition grafting material is frequent in the treatment of osteoarthritis of the base of the thumb [13,17] or tendinous [6,15,22] and ligamentous injuries of the hand [10,14]. The use of different tendons as grafting material is extensive in hand surgery.…”

Section: Introductionmentioning

confidence: 99%

Anatomic Study of the Abductor Pollicis Longus: A Source for Grafting Material of the Hand

Bravo

Barco

2010

Clinical Orthopaedics &Amp; Related Research

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Interposition grafting material is used frequently to treat osteoarthritis of the base of the thumb or tendinous and ligamentous injuries of the hand. The observation of duplicated tendons in the first dorsal compartment of the hand prompted us to explore the possibility of using the accessory abductor pollicis longus (AAPL) tendon as grafting material. Based on dissections of 78 cadaveric upper limbs, we describe the number of tendons in the first dorsal compartment of the hand, the number of muscle bellies, their innervation, their insertion site, and the tendon dimensions to determine whether the AAPL can be considered a true tendon. The AAPL was present in 85% of the hands. Average length, width, and thickness (in millimeters) of the APL were of 69.3, 5.2, and 2.1, respectively. Average length, width, and thickness (in millimeters) of the AAPL were of 69.2, 3.3, and 1.6, respectively. No differences in dimension of the tendons were found between the APL and the AAPL. The dimensions of the tendinous portion of the AAPL are similar to those of the APL and can be considered a true tendon. When present, the AAPL is a suitable source of local grafting material.

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“…In the chronic setting, however, treatment results are less consistent [2,12]. While still not entirely predictable, in the chronic setting, static ligamentous reconstruction or dynamic tendon transfer seem to have greater success than primary repair [4,5,12,19,22,24].…”

Section: Discussionmentioning

confidence: 99%

Outcomes after Repair of Subacute-To-Chronic Grade III Metacarpophalangeal Joint Collateral Ligament Injuries in Fingers are Suboptimal

Wong¹,

Lutsky

Beredjiklian

2013

Hand (New York, N,Y.)

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Purpose Although injury to the collateral ligaments of the metacarpophalangeal joint (MPJ) of the fingers is less common than corresponding injuries in the thumb, similar disability may result from chronic untreated injuries. We evaluated injury characteristics and the outcome after primary repair of subacute to chronic grade III collateral ligament injuries of the MPJs of the fingers. Methods We retrospectively reviewed all patients who underwent primary repair of a finger MPJ collateral ligament over a 3-year period. Twenty-five digits in 23 patients with subacute to chronic injuries were identified, all of which had complete MPJ collateral ligament tear. Postoperatively, we assessed disability using DASH scores and evaluated joint stability, range of motion, and grip strength. These measures were compared to preoperative data to assess results. Post hoc analysis was used to compare the level of disability between index and small radial collateral ligaments and other finger CL injuries. Results Intraoperative findings revealed complete tears in all cases and all ligaments were of sufficient quality to permit primary repair using a suture anchor. The average preoperative DASH score was 40 (range 17-77) in 7 patients (nine fingers) where this was available. Postoperative DASH scores were available in 19 patients (21 fingers). The average postoperative DASH score was 19 (range 0-65). In the subgroup of patients with preoperative and postoperative DASH scores, there was no statistically significant difference after surgery (preop DASH 39.1 vs. postop DASH 23.8, p =0.17). The average grip strength as a percentage of the contralateral hand was 68 % (range 32-100 %). The average postoperative MPJ arc of motion was 75°(range 50-90°). Post hoc analysis showed statistically significant higher postoperative DASH scores among small finger RCL repairs compared to other finger CL repairs (p =0.007). Discussion Primary repair of complete MPJ collateral ligament injuries of the fingers may be performed in the subacute to chronic setting. Although joint stability was restored, patients continued to have decreased grip strength and residual disability.

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Ligament replacement for chronic instability of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb

Cited by 111 publications

References 8 publications

Complications and failures of the trapeziometacarpal Maia® prosthesis: A series of 156 cases

Complications and failures of the trapeziometacarpal Maia® prosthesis: A series of 156 cases

Anatomic Study of the Abductor Pollicis Longus: A Source for Grafting Material of the Hand

Outcomes after Repair of Subacute-To-Chronic Grade III Metacarpophalangeal Joint Collateral Ligament Injuries in Fingers are Suboptimal

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