scholarly journals Botox and Thumb MCP Radial Collateral Ligament Reconstruction

2017 ◽  
Vol 07 (02) ◽  
pp. 156-159 ◽  
Author(s):  
Robert Cates ◽  
Jeffrey Brault ◽  
Sanjeev Kakar
Keyword(s):  
Botulinum Neurotoxin ◽  
Ligament Reconstruction ◽  
Adductor Muscle ◽  
Adductor Pollicis ◽  
Collateral Ligament ◽  
Cast Immobilization ◽  
Adductor Pollicis Muscle ◽  
Radial Collateral Ligament ◽  
Botox Injection ◽  
Deforming Forces

Background We report the use of botulinum toxin to aid in the treatment of chronic radial collateral ligament insufficiency of the thumb. Case Description Treatment included autograft tendon reconstruction and cast immobilization. Six weeks postoperatively, prior to hand therapy, the patient underwent an ultrasound-guided botulinum neurotoxin A injection into the adductor pollicis muscle to negate its deforming forces on the reconstruction. The patient made an excellent recovery and 1 year postoperatively was pain free and had a stable radial collateral ligament (RCL) upon examination. Literature Review The outcomes of RCL repair and reconstruction are unpredictable, in part, due to the strong opposing forces of the adductor pollicis. Clinical Relevance The use of Botox injection may enhance the outcomes of RCL repair or reconstruction by neutralizing the deforming forces of the adductor muscle.

The ‘‘Two Fleck Sign’’ for an Occult Stener Lesion

2008 ◽  
Vol 33 (2) ◽  
pp. 208-211 ◽  
Author(s):  
SUNIL THIRKANNAD ◽  
THOMAS W. WOLFF
Keyword(s):  
Retrospective Review ◽  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Adductor Pollicis ◽  
Collateral Ligament ◽  
Fracture Fragment ◽  
Adductor Pollicis Muscle ◽  
X Ray ◽  
Stener Lesion

We report a case of distal pull-off of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb with two fracture fragments. The more obvious fracture fragment, seen on plain X-ray to be lying adjacent to the expected location of the attachment of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, was, in fact, unassociated with it and was part of the attachment of the adductor pollicis muscle. A second smaller fleck of bone which was attached to the displaced collateral ligament was only observed on plain X-ray on retrospective review. This second fleck of bone identified that this was a Stener lesion, requiring surgical reattachment of the ligament. Similar cases in the literature are reviewed and the use of MRI in detecting these lesions is discussed.

scholarly journals Risk Factors for Failure After Anterior Cruciate Ligament Reconstruction in a Pediatric Population: A Prediction Algorithm

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199116
Author(s):  
Nicholas J. Lemme ◽  
Daniel S. Yang ◽  
Brooke Barrow ◽  
Ryan O’Donnell ◽  
Alan H. Daniels ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Adult Patients ◽  
Collateral Ligament ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: Anterior cruciate ligament reconstruction (ACLR) in pediatric patients is becoming increasingly common. There is growing yet limited literature on the risk factors for revision in this demographic. Purpose: To (1) determine the rate of pediatric revision ACLR in a nationally representative sample, (2) ascertain the associated patient- and injury-specific risk factors for revision ACLR, and (3) examine the differences in the rate and risks of revision ACLR between pediatric and adult patients. Study Design: Case-control study; Level of evidence, 3. Methods: The PearlDiver patient record database was used to identify adult patients (age ≥20 years) and pediatric patients (age <20 years) who underwent primary ACLR between 2010 and 2015. At 5 years postoperatively, the risk of revision ACLR was compared between the adult and pediatric groups. ACLR to the contralateral side was also compared. Multivariate logistic regression was used to determine the significant risk factors for revision ACLR and the overall reoperation rates in pediatric and adult patients; from these risk factors, an algorithm was developed to predict the risk of revision ACLR in pediatric patients. Results: Included were 2055 pediatric patients, 1778 adult patients aged 20 to 29 years, and 1646 adult patients aged 30 to 39 years who underwent ACLR. At 5 years postoperatively, pediatric patients faced a higher risk of revision surgery when compared with adults (18.0 % vs 9.2% [adults 20-29 years] and 7.1% [adults 30-39 years]; P < .0001), with significantly decreased survivorship of the index ACLR ( P < .0001; log-rank test). Pediatric patients were also at higher risk of undergoing contralateral ACLR as compared with adults (5.8% vs 1.6% [adults 20-29 years] and 1.9% [adults 30-39 years]; P < .0001). Among the pediatric cohort, boys (odds ratio [OR], 0.78; 95% CI, 0.63-0.96; P = .0204) and patients >14 years old (OR, 0.62; 95% CI, 0.45-0.86; P = .0035) had a decreased risk of overall reoperation; patients undergoing concurrent meniscal repair (OR, 1.84; 95% CI, 1.43-2.38; P < .0001) or meniscectomy (OR, 2.20; 95% CI, 1.72-2.82; P < .0001) had an increased risk of revision surgery. According to the risk algorithm, the highest probability for revision ACLR was in girls <15 years old with concomitant meniscal and medial collateral ligament injury (36% risk of revision). Conclusion: As compared with adults, pediatric patients had an increased likelihood of revision ACLR, contralateral ACLR, and meniscal reoperation within 5 years of an index ACLR. Families of pediatric patients—especially female patients, younger patients, and those with concomitant medial collateral ligament and meniscal injuries—should be counseled on such risks.

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