Treatment of Chronic Injuries of the Ulnar Collateral Ligament of the Thumb Using a Free Tendon Graft and Bone Suture Anchors

2000 ◽  
Vol 25 (2) ◽  
pp. 208-211 ◽  
Author(s):  
G. I. MITSIONIS ◽  
S. E. VARITIMIDIS ◽  
G. G. SOTEREANOS
Keyword(s):  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Tendon Graft ◽  
Pinch Strength ◽  
Suture Anchors ◽  
Collateral Ligament ◽  
The Mean ◽  
Chronic Injuries ◽  
Weather Changes ◽  
Loss Of Motion

We report the results of a simple technique, using bone suture anchors and free tendon graft, for the reconstruction of chronic injuries of the ulnar collateral ligament complex at the thumb metacarpophalangeal (MP) joint. Our series includes 20 patients, with a mean age of 29 years. The mean follow-up period was 42 months. Using the Glickel grading system, 14 patients had excellent results and six had good results. Seventeen patients had no pain and three complained of mild pain with weather changes. Fourteen patients regained full stability of the MP joint and six had mild laxity. The mean loss of pinch strength was 18% compared with the contralateral thumb. The mean loss of motion at the metacarpophalangeal joint was 21%.

scholarly journals Percutaneous Reconstruction of the Ulnar Collateral Ligament of the Metacarpophalangeal Joint of the Thumb: Technique and Results

2020 ◽  
Vol 48 (02) ◽  
pp. 101-108
Author(s):  
Juan Manuel Herrera ◽  
Lucas Herrera ◽  
Pablo Rotella ◽  
Raquel Cantero Téllez ◽  
Jimena Castellanos ◽  
...  
Keyword(s):  
Grip Strength ◽  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Tendon Graft ◽  
Pinch Strength ◽  
Percutaneous Technique ◽  
Dash Score ◽  
Joint Movement ◽  
Collateral Ligament ◽  
Contralateral Limb

Abstract Objectives The present study aims to describe a new percutaneous technique for the reconstruction of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb with a tendon graft, and to evaluate the functional outcomes and stability six months postoperatively. Material and methods The percutaneous ligamentoplasty technique was performed with a palmaris longus tendon graft and tenodesis screws in 6 patients with ulnar instability of the thumb (> 30° degrees of radial deviation) for more than 6 weeks. Range of motion, grip strength, and pinch strength (lateral/key pinch, tip pinch, and palmar pinch) were assessed in comparison to the contralateral limb, as well as the Quick Disabilities of the Arm, Shoulder and Hand (DASH) score. Results At 6 months, the joint movement was of 100%, the grip strength was of 94.8%, the key pinch was of 95%, the palmar pinch was of 85.7%, and the tip pinch was of 93.5% compared to the contralateral limb. The internal tilt was of 14° compared to 9° at the contralateral limb. The Quick DASH score decreased from 24.2 to 2.6 points. Conclusion We devised this versatile surgical procedure to obtain early mobility with the advantages related to the percutaneous techniques.

Reconstructive Procedure to Repair Chronic Injuries to the Collateral Ligament of Metacarpophalangeal Joints of the Hand

Hand Surgery ◽  
2003 ◽  
Vol 08 (01) ◽  
pp. 81-85 ◽  
Author(s):  
Yoshinori Oka ◽  
Hiroki Harayama ◽  
Masayoshi Ikeda
Keyword(s):  
Middle Finger ◽  
Tendon Graft ◽  
Bone Tunnel ◽  
Pinch Strength ◽  
Reconstructive Procedure ◽  
Collateral Ligament ◽  
Joint Range Of Motion ◽  
Palmaris Longus Tendon ◽  
Chronic Injuries ◽  
Joint Range

We have devised a reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal (MCP) joints. It comprises palmaris longus tendon grafting into a bone tunnel and suturing onto the base of the residual ligament without involving fixation of the tendon graft stump. Thirteen patients were treated for injured MCP joints: thumb/ulnar, ten cases; thumb/radial, two; and middle finger/radial, one. All patients had pain and instability of average 41° in the affected MCP joints. The patients were followed at an average period of five years and nine months. Pain and joint instability disappeared in all patients. The mean MCP joint range of motion (ROM) was 1° on extension and 58° on flexion. The tip pinch strength averaged 4.8 kg. The gratifying results obtained using this method are attributed to the fact that optimal tension of the ligament and satisfactory ROM can be achieved during the course of rehabilitation.

scholarly journals Clinical results of the BoneWelding®Fiji® anchor for the treatment of Stener lesions of the thumb

2020 ◽  
Author(s):  
Tobias Kastenberger ◽  
Peter Kaiser ◽  
Gernot Schmidle ◽  
Kerstin Stock ◽  
Stefan Benedikt ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Range Of Motion ◽  
Traumatic Event ◽  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Contralateral Side ◽  
Pinch Strength ◽  
Dash Score ◽  
Collateral Ligament

Abstract Introduction A new technology (Sportwelding®) was recently presented, which uses ultrasonic energy to meld a resorbable suture anchor at the interface with the host bone. A standardized clinical use was not investigated yet. This study prospectively evaluated the surgical and clinical outcomes of the Fiji Anchor® (Sportwelding®, Schlieren, Switzerland) in the repair of an ulnar collateral ligament lesion of the metacarpophalangeal joint of the thumb. Material and methods The range of motion, grip and pinch strength, disability of arm, shoulder and the hand (DASH) and patient rated evaluation (PRWE) score, pain, satisfaction, complications and adverse events were assessed in 24 patients after surgical treatment for an acute displaced rupture or avulsion of the ulnar collateral metacarpophalangeal ligament of the thumb using the Fiji Anchor® after 6, 12 and 52 weeks. Results At final follow up, the range of motion of the metacarpophalangeal joint reached almost the contralateral side (49.3° SD 11.7°). Thumb opposition showed a Kapandji score of 9.7 (SD 0.5; range 9–10). Grip strength, the lateral, tip and the three jaw pinch showed nearly similar values compared to the contralateral side (83–101%). Pain was low (0.2 SD 0.7 at rest and 0.6 SD 1.0 during load). The DASH score was 5.0 (SD 7.3) and the PRWE score was 4.1 (SD 9.0). 81% of patients were very satisfied at final follow-up. Two patients were rated unstable during the follow-up period due to a second traumatic event. Three cases experienced difficulties during anchor insertion, whereby incorrect anchor insertion resulted in damage to the suture material; however, this was resolved after additional training. Conclusion One advantage of this anchor appears to be its stable fixation in cancellous bone. The surgical treatment of an ulnar collateral ligament lesion of the thumb using the Fiji Anchor® can lead to an excellent clinical outcome with a minor complication rate; however, long-term dangers and the cost effectiveness of the procedure are not known yet.

scholarly journals Effect of Ulnar Collateral Ligament Reconstruction on Pitch Accuracy, Velocity, and Movement in Major League Baseball Pitchers

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096853
Author(s):  
Braden McKnight ◽  
Nathanael D. Heckmann ◽  
Xiao T. Chen ◽  
Kevork Hindoyan ◽  
J. Ryan Hill ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Poor Performance ◽  
Return To Play ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Major League ◽  
The Mean ◽  
Performance Statistics

Background: Ulnar collateral ligament (UCL) reconstruction is frequently performed on Major League Baseball (MLB) pitchers. Previous studies have investigated the effects of UCL reconstruction on fastball and curveball velocity, but no study to date has evaluated its effect on fastball accuracy or curveball movement among MLB pitchers. Purpose/Hypothesis: The primary purpose of this study was to determine the effects of UCL reconstruction on fastball accuracy, fastball velocity, and curveball movement in MLB pitchers. Our hypothesis was that MLB pitchers who underwent UCL reconstruction would return to their presurgery fastball velocity, fastball accuracy, and curveball movement. The secondary purpose of this study was to determine which factors, if any, were predictive of poor performance after UCL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: MLB pitchers who underwent UCL reconstruction surgery between 2011 and 2012 were identified. Performance data including fastball velocity, fastball accuracy, and curveball movement were evaluated 1 year preoperatively and up to 3 years of play postoperatively. A repeated-measures analysis of variance with a Tukey-Kramer post hoc test was used to determine statistically significant changes in performance over time. Characteristic factors and presurgery performance statistics were compared between poor performers (>20% decrease in fastball accuracy) and non—poor performers. Results: We identified 56 pitchers with a total of 230,995 individual pitches for this study. After exclusion for lack of return to play (n = 14) and revision surgery (n = 3), 39 pitchers were included in the final analysis. The mean presurgery fastball pitch-to-target distance was 32.9 cm. There was a statistically significant decrease in fastball accuracy after reconstruction, which was present up to 3 years postoperatively ( P = .007). The mean presurgery fastball velocity of 91.82 mph did not significantly change after surgery ( P = .194). The mean presurgery curveball movement of 34.49 cm vertically and 5.89 cm horizontally also did not change significantly ( P = .937 and .161, respectively). Conclusion: Fastball accuracy among MLB pitchers significantly decreased after UCL reconstruction for up to 3 years postoperatively. There were no statistically significant differences in characteristic factors or presurgery performance statistics between poor and non--poor performers.

scholarly journals Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095914
Author(s):  
Justin C. Kennon ◽  
Erick M. Marigi ◽  
Chad E. Songy ◽  
Chris Bernard ◽  
Shawn W. O’Driscoll ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Ulnar Neuropathy ◽  
Complication Rates ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Functional Scores ◽  
The Mean

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

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