Injuries to the Collateral Ligaments of the Metacarpophalangeal Joint of the Thumb, Including Simultaneous Combined Thumb Ulnar and Radial Collateral Ligament Injuries, in National Football League Athletes

2016 ◽  
Vol 45 (1) ◽  
pp. 195-200 ◽  
Author(s):  
Brian C. Werner ◽  
Nicole S. Belkin ◽  
Steve Kennelly ◽  
Leigh Weiss ◽  
Ronnie P. Barnes ◽  
...  
Keyword(s):  
Physical Examination ◽  
National Football League ◽  
Surgical Repair ◽  
Case Series ◽  
Injury Pattern ◽  
Return To Play ◽  
Ligament Injury ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Radial Collateral Ligament

Background: Thumb collateral ligament injuries occur frequently in the National Football League (NFL). In the general population or in recreational athletes, pure metacarpophalangeal (MCP) abduction or adduction mechanisms yield isolated ulnar collateral ligament (UCL) and radial collateral ligament (RCL) tears, respectively, while NFL athletes may sustain combined mechanism injury patterns. Purpose: To evaluate the incidence of simultaneous combined thumb UCL and RCL tears among all thumb MCP collateral ligament injuries in NFL athletes on a single team. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all thumb injuries on a single NFL team from 1991 to 2014 was performed. All players with a thumb MCP collateral ligament injury were included. Collateral ligament injuries were confirmed by review of both physical examination findings and magnetic resonance imaging. Player demographics, surgical details, and return-to-play data were obtained from the team electronic medical record and surgeons’ records. Results: A total of 36 thumbs in 32 NFL players were included in the study, yielding an incidence of 1.6 thumb MCP collateral ligament injuries per year on a single NFL team. Of these, 9 thumbs (25%) had a simultaneous combined UCL and RCL tear injury pattern confirmed on both physical examination and MRI. The remaining 27 thumbs (75%) were isolated UCL injuries. All combined UCL/RCL injuries required surgery due to dysfunction from instability; 63.0% of isolated UCL injuries required surgical repair ( P = .032) due to continued pain and dysfunction from instability. Repair, when required, was delayed until the end of the season. All players with combined UCL/RCL injuries and isolated UCL injuries returned to play professional football the following season. Conclusion: Simultaneous combined thumb UCL and RCL tear is a previously undescribed injury pattern that occurred in 25% of thumb MCP collateral ligament injuries on a single NFL team over a 23-year period. All players with combined thumb UCL/RCL injuries required surgical repair, which was significantly higher compared with players with isolated UCL injuries. Team physicians and hand surgeons treating elite football players with suspected thumb collateral ligament injuries should examine for RCL and UCL instability and consider MRI if any concern exists for a combined ligament injury pattern, as this injury is likely frequently missed.

scholarly journals Return to Play Following Isolated and Combined Anterior Cruciate Ligament Reconstruction: 25+ Years of Experience Treating National Football League Athletes

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095900
Author(s):  
Michael Khair ◽  
Jonathan Riboh ◽  
Jaicus Solis ◽  
Jim Maurer ◽  
J. Britt Brown ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Multivariate Analysis ◽  
Ligament Reconstruction ◽  
National Football League ◽  
Cruciate Ligament ◽  
Case Series ◽  
Return To Play ◽  
Collateral Ligament ◽  
Acl Injuries ◽  
Anterior Cruciate

Background: The first case series to report on return to play (RTP) in National Football League (NFL) players after primary anterior cruciate ligament (ACL) reconstruction (ACLR) published an RTP rate of 63%. Other studies that have attempted to estimate RTP after ACLR in these elite athletes have been largely based on secondary sources. This study is the second to report the authors’ own results in treating ACL injuries in NFL players spanning a study period of 25+ years. Purpose: To report the senior authors’ experience treating ACL injuries in NFL players as well as revisit the concept of RTP as it is currently used to measure successful surgical outcomes in professional athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 47 NFL players were treated at our institution for knee injuries that included a complete tear of the ACL; of these, 41 were primary ACLR and 6 were revision ACLR. Of the primary ACLRs, 6 were classified as ACL plus additional ligament and 3 were classified as multiligament. Return to game play (RTGP) was defined as returning to play in a regular-season game. Successful return to previous participation (RTPP) was defined as return to a level of participation equal to the level the player had reached before injury. Multivariate analysis was used to assess predictors of successful RTPP. Results: Using the RTGP criteria proposed by prior authors, the RTGP after primary ACLR was 73%. Using our proposed RTPP criteria, 87.8% of players successfully returned to the same level of participation after primary ACLR. RTGP percentage for all NFL players after ACLR (including multiligament injuries) was 67.6%, and the overall RTPP for those patients was 87.8%. In multivariate analysis, age ≤25 years was predictive of successful RTPP. High draft picks and offensive players played more seasons after primary ACLR. ACL graft rupture occurred in 4.3% of this cohort. Contralateral ACL tear occurred in 8.5%. Conclusion: Regardless of which definition is used to measure a successful outcome after ACLR surgery, the findings of this study suggest that successful return after primary ACLR in NFL athletes is higher than previously reported. While concomitant reconstruction of a single collateral ligament did not affect RTPP, revision ACLR or bicruciate plus collateral ligament reconstruction was associated with a lower RTPP rate. Age ≤25 years predicted successful RTPP. The risk of a future ACL tear of either knee after index reconstruction was approximately 13%.

Entrapment of the index finger radial collateral ligament in the metacarpophalangeal joint: A case report

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110558
Author(s):  
Eric X Jiang ◽  
Michael A Korn ◽  
Elizabeth A King ◽  
Marnix van Holsbeeck
Keyword(s):  
Case Report ◽  
Index Finger ◽  
Metacarpophalangeal Joint ◽  
Injury Pattern ◽  
Acute Injury ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Radial Collateral Ligament ◽  
Superb Microvascular Imaging ◽  
Microvascular Imaging

Introduction Digital collateral ligament injuries are common hand injuries that can cause significant pain and functional impairment. Ultrasonography can be useful in the evaluation of these ligamentous injuries, as it is both cost-effective and allows for easy, dynamic evaluation during imaging. Case report We report a rare sonographic finding of an index finger radial collateral ligament injury that was found to have a flap of the ligament entrapped within the metacarpophalangeal joint, which to our knowledge has not been described previously. We correlate this finding with an intraoperative image of the entrapment of the collateral ligament. We also report on the novel application of superb microvascular imaging to aid in the diagnosis of digital collateral ligament injury. Discussion This particular injury pattern has not been reported in the literature previously and likely explains the patient’s lack of improvement with nonoperative management. Our finding is similar to a Stener lesion seen in a thumb ulnar collateral ligament injury in which the ligament is unable to heal due to entrapment. In addition, using superb microvascular imaging (SMI), we were able to visualize hyperemia to surrounding structures and the ligament itself which suggested an acute injury. Conclusion We anticipate that this case report will provide sonographers with knowledge and images of this specific injury pattern to the digital collateral ligaments.

Nonsurgical Management of Ulnar Collateral Ligament Injuries is Tentatively Successful in Overhead Athletes: A Critical Appraisal of Case Series

2020 ◽  
Vol 25 (5) ◽  
pp. 213-220
Author(s):  
Nathan Oakes ◽  
Jennifer M. Medina McKeon
Keyword(s):  
Odds Ratio ◽  
Critical Appraisal ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Overhead Athletes ◽  
Nonsurgical Management ◽  
Ligament Rupture

Since its inception, surgical management of the ulnar collateral ligament (UCL) is fairly standard; however, the invasive, costly, and time-intensive nature of UCL surgery may be restrictive to some athletes. Electronic databases were searched starting from the year 2013 to September 2018. Extracted data included frequencies of (a) return to play (RTP); (b) return to same level of play (RTSP); (c) athlete’s position; (d) complete reconstitution of the UCL; and (e) the location of ligament rupture (proximal or distal). Proportions of success/failure for selected outcomes were calculated. Additionally, an odds ratio (OR) (95% confidence interval [CI]) determined the association between tear location (proximal vs. distal) and nonsurgical success. A total of 169 athletes underwent nonsurgical management of UCL injury in the seven included studies. Sports included baseball, gymnastics, softball, hockey, volleyball, and tennis. Overall, 83% (n = 140) were able to RTP and 72% (n = 121) were able to RTSP. Those with proximal UCL tears had a RTSP rate of 82% (n = 56) compared to 42% (n = 13) of those with a distal tear. Proximal tears were associated with higher rates of successful outcomes in RTP and RTSP (OR = 6.5 [2.5,16.7], p < .001). In baseball, 76% (n = 38) of pitchers were able to RTSP compared to 90% (n = 9) of position players. When visualized using MRI, 96% (n = 22) of athletes had full UCL reconstitution following nonsurgical management. Based on the pooled outcomes of included studies, nonsurgical management of a UCL injury was reasonably successful for RTP and RTSP rates in professional athletes, with a better chance of success for proximal tears compared to distal and incomplete tears compared to complete. The exploratory nature of utilizing nonsurgical management for UCL sprains in athletes, by way of the case series, appears to be fairly well established, but an upgrade in study design is warranted.

Radial Collateral Ligament Injury of the Little Finger Proximal Interphalangeal Joint in Young Pianists

2014 ◽  
Vol 39 (8) ◽  
pp. 1535-1539 ◽  
Author(s):  
Hyun Sik Gong ◽  
Hoyune Esther Cho ◽  
Seung Hwan Rhee ◽  
Jihyeong Kim ◽  
Young Ho Lee ◽  
...  
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Radial Collateral Ligament ◽  
Little Finger

Management of feline carpal injuries: What are the options and when is arthrodesis indicated?

2019 ◽  
Vol 21 (9) ◽  
pp. 809-823 ◽  
Author(s):  
Rachel M Basa ◽  
Kenneth A Johnson
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Evidence Base ◽  
Careful Examination ◽  
Current Evidence ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Radial Collateral Ligament ◽  
Current Evidence Base ◽  
Direct Extrapolation

Practical relevance: Feline carpal injuries are usually caused by falls from a height that result in hyperextension injury or antebrachiocarpal luxation or subluxation. Isolated ligamentous damage or fracture of the carpus is unusual; it is more common to have a combination of both in the cat. These injuries can be debilitating since cats climb and jump from great heights, and have a greater range of antebrachial pronation and supination than dogs. Anatomy: There are differences in the anatomy of the feline and canine carpus. In particular, cats only have a single short radial collateral ligament, also known as the medial collateral ligament. This means that, in the cat, antebrachiocarpal subluxation is possible with rupture of the dorsal joint capsule and short radial collateral ligament alone. Clinical challenges: Many feline carpal injuries can be treated without performing pancarpal arthrodesis. However, determining which ligaments and joint levels are affected requires careful examination and often stress radiography. When pancarpal arthrodesis is performed in the cat, it has been reported to reduce the height of jumping and to increase reluctance to climb. This is speculated to be due to reduced pronation and supination movement of the carpus. Evidence base: The current evidence base for management of feline carpal injuries is grade III or IV, with most of the studies being retrospective case series involving cadaveric dissection or direct extrapolation from published information about the dog. There are few guidelines regarding the optimal treatment options for carpal injuries in the cat.

scholarly journals Epidemiology of Surgical Treatment of Youth Sports Injuries in the United States

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0016
Author(s):  
Nicholas Bonazza ◽  
Nicholas Sterling ◽  
Djibril Ba ◽  
Guodong Liu ◽  
William L. Hennrikus ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Sports Injuries ◽  
Youth Sports ◽  
The United States ◽  
Ligament Injury ◽  
National Database ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Acl Injuries ◽  
Over Time

Objectives: There is concern that the number of youth sports injuries are increasing in the United States. The purpose of our study was to utilize a large national database to characterize the incidence of surgical procedures for various pediatric sports orthopedic injuries as well as trends amongst certain patient populations. Methods: A search of the Truven Health MarketScan Database (over 39 million patients per year) was conducted to identify the incidence of various orthopaedic conditions as well as associated surgical procedures from 2008 through 2014 amongst patients 10-19 years of age. The database was searched for patients who had International Classification of Disease (ICD-9) codes and Current Procedure Terminology (CPT) codes for operative treatment for the following conditions: anterior cruciate ligament (ACL) injuries, knee collateral ligament injuries, chondral injuries, Osgood-Schlatter syndrome, and elbow ulnar collateral ligament (UCL) injury. Patients identified were characterized by gender, age, and year of injury as well as surgery. Regression analysis was used to evaluate differences in surgery trends between individual patient groups delineated by age, and gender. The Cochran-Armitage trend test was used to identify significant differences in surgery trends seen yearly. Results: A total of 660,982 patients sustained an injury with 165,590 (25%) having related surgery during the study period. Surgery was performed for 65,224 (54.4%) patients for ACL injury, 3,839 (3.7%) patients for knee collateral ligament injury, 91,217 (30.6%) patients for chondral injury, 211 (0.2%) patients for Osgood-Schlatter syndrome, and 5,099 (22.71%) patients for UCL injury. Only knee collateral ligament injuries demonstrated an increase in the rate of surgical intervention over time, from 2% in 2008 to 5.3% in 2014 (p < .0001). Age greater than 15 yrs was associated with a higher likelihood for surgical intervention for all diagnoses (p < .001). Average age of surgical intervention ranged from 15.9 yrs for Osgood-Schlatter syndrome to 16.8 yrs for a UCL injury and did not change for any diagnosis over time. Females were more likely to undergo surgery for ACL injuries (OR = 1.5, p < .0001), knee collateral ligament injury (OR = 1.7, p < .0001), and Osgood-Schlatter syndrome (OR = 1.8, p < .0001) while males were more likely to undergo surgery for chondral injuries (OR = 1.6, p < .0001) and UCL injuries (OR = 1.1, p < .0005). Both male and female patients demonstrated a sustained increase in surgery for knee collateral ligament injuries over the study period, with no other diagnosis showing trend changes secondary to gender. Conclusion: Our study found the incidence of surgical treatment of five common sports injuries remained stable over time with only knee collateral ligament injuries demonstrating an increase in surgical incidence over the study period. There was no significant change over time in the average age of surgical intervention for all diagnosis. Females were more likely to undergo surgery for ACL injuries, knee collateral ligament injuries, and Osgood-Schlatter syndrome while males were more likely to undergo surgery for chondral and UCL injuries. Despite concern that incidence of youth sports injuries and surgeries are increasing over time and that average age of these injuries is decreasing, our data using a large US National Database does not support this.

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