Collateral Ligament Of Metacarpophalangeal Joint Research Articles

Novel figure-of-eight reconstruction with free tendon graft for unrepairable collateral ligament of the thumb metacarpophalangeal joint

ObjectivesThis study aimed to report surgical technique and clinical outcomes for a novel figure-of-eight collateral ligament reconstruction technique using palmaris longus autograft for chronic irreparable collateral ligament injury of the thumb metacarpophalangeal joint. Material and methodsThe Jobe elbow collateral ligament reconstruction method was adapted for thumb metacarpophalangeal joint collateral ligament reconstruction. Sixteen reconstructions (7 ulnar collateral ligament, 9 radial collateral ligament) using palmaris longus autograft were reviewed retrospectively. Surgery was performed at a mean 12 months post-injury. All 16 patients were followed up for more than 1 year. Metacarpophalangeal joint radial and ulnar deviation, metacarpophalangeal and interphalangeal joint range of motion, key pinch and grip strength, Glickel functional grade and QuickDASH score were evaluated. ResultsPreoperative radial or ulnar deviation improved from 19.3° to 5.3° postoperatively. Metacarpophalangeal range of motion improved from 31.5° to 46.6°, and interphalangeal range of motion from 48.4° to 65.6°. Preoperative key pinch and grip strength were respectively 49% and 81% of contralateral values and improved to 82% and 87%. On Glickel grade, 9 cases were excellent and 7 good. ConclusionThe novel Jobe-like figure-of-eight reconstruction technique using palmaris longus graft was useful for reconstructing irreparable thumb metacarpophalangeal joint instability without an incision on the opposite side or an additional implant. Level of evidenceTherapeutic study, level IV.

Return to Sport and Performance After Thumb Metacarpophalangeal Joint Collateral Ligament Surgery in the National Basketball Association.

Introduction Basketball players are at increased risk of thumb collateral ligament injury (ulnar collateral ligament (UCL) and radial collateral ligament (RCL)). Methods The National Basketball Association (NBA) players with thumb collateral ligament surgery were identified using publicly available data. Performance statistics, ligament injuries (UCL or RCL), return to sport (RTS) time, laterality, and injury dates were recorded. Cases were matched 1:1 with controls based on age (±1 year), body mass index (BMI), NBA experience (±1 year), and performance statistics prior to the index date. RTS was defined as playing in one NBA game postoperatively. Career longevity was evaluated. Summary statistics were calculated, and Student's t-tests (ɑ = 0.001) were performed. Results All 47 players identified with thumb collateral ligament surgeries returned to sport. Thirty-three players (age: 26.9 ± 3.0) had one year of postoperative NBA experience for performance analysis. Career length (case: 9.6 ± 4.1, control: 9.4 ± 4.3, p > 0.001) was not significantly different from controls (p > 0.001). The same season time to RTS (n = 20) was 7.1 ± 2.4 weeks. Off-season or season-ending surgery (n = 13) RTS time was 28.4 ± 18.7 weeks. Neither thumb collateral ligament (UCL, n = 7; RCL, n = 10; unknown, n = 16) had an identifiable difference between the groups when evaluating career length. Career length, games/season, and performance were not different for players who underwent surgery on their dominant thumb (63.6%, 21/33) compared to controls (p > 0.001). Conclusion RTS rate is high in NBA athletes undergoing thumb collateral ligament surgery. Players do not experience decreased performance or career length due to thumb collateral ligament surgery, regardless of a dominant or non-dominant thumb injury.

Cartilage Degeneration of the Metacarpal Condyle and Enthesopaties of The Collateral Ligaments of Equine Metacarpophalangeal Joint

Articular degeneration can be characterized by fibrillation and eburnation of the articular layers of the metacarpophalangeal (MP) joint. Structural changes within the articular joint predispose the development of osteophytes, enthesophytes and, in many cases is associated with changes the collateral ligaments of the MP joint. The aim of the present study was to investigate the relationship between degenerative processes of the articular cartilage and the enthesopathies of collateral ligaments (superficial or deep portion) of the equine MP joint, using radiographic, ultrasonographic and anatomopathological exam, as well as establishing their sensitivity. Thirty equine forelimbs were selected from animals that died due to various clinical conditions with an average age of 5.7 years which came from a private clinic or sent to the Laboratory of Veterinary Pathology of UFSM. The specimens were placed in a hydraulic press and submitted to radiographic evaluation of the MP joint (lateromedial, flexed lateromedial, dorsopalmar, dorsolateral-palmaromedial oblique 450 and dorsomedial-palmarolateral oblique 450 projections). Transversal and longitudinal ultrasound images of the dorsal and collateral aspect of the MP joint were obtained using a Sonosite Edge machine with a 5 to 10 MHz linear transducer. Subsequently, the specimens were sent for gross and histopathological examination. A highly positive correlation (P value <.001) was observed between ultrasonographic and macroscopic techniques, showing a relationship between the cartilaginous degenerations of the MP joint and the medial and lateral LC enthesopathies.

MRI Utility in Hand Surgery

Background: Magnetic resonance imaging (MRI) is frequently used in the diagnosis of upper extremity conditions. We hypothesize that the results often do not change treatment. The purpose of the present study was to prospectively assess the extent to which MRI findings alter patient management. Methods: Ten hand surgeons who were ordering an MRI (elbow or distal) completed a standardized questionnaire. Prior to obtaining the MRI, the surgeon recorded their pre-MRI diagnosis and recommended treatment if no MRI could be obtained. Following the MRI, the surgeon recorded their post-MRI diagnosis and ultimate treatment recommendation. Finally, the surgeon answered whether the MRI was helpful, and if so, how it helped guide their treatment. Descriptive statistics were performed. Results: One hundred eighty-seven MRIs were ordered. The most common reasons for ordering an MRI were the evaluation of presumed occult scaphoid fracture, ulnar wrist pain, metacarpophalangeal joint collateral ligament injury, and mass. The surgeon agreed with the radiologist's interpretation of the MRI in 88% of cases. Overall, surgeons found the MRI to be helpful in 92% of cases, and the recommended treatment changed as a result of the MRI findings in 19% (35/187) of patients. Of these 35 patients, 9 had a pre-MRI diagnosis that was concordant with the MRI findings, but the proposed management of the patient changed after the MRI. Conclusions: Hand surgeons infrequently change their treatment plan based on MRI findings. Given the importance of cost-efficient care, indications for use of MRI may need to be re-evaluated.

Arthroscopy-aided fixation for metacarpophalangeal joint collateral ligament injury accompanied by osteochondral avulsion injury: our results and surgical technique

Aim: Though metacarpophalangeal joint collateral ligament injuries are commonly observed, the presence of accompanying avulsed osteochondral fragment or aponeurosis injury in adult patients is a situation that may require definite surgical treatment. Our study investigated patients attending our clinic after acute hand trauma with radial or ulnar collateral ligament injury who underwent arthroscopy-aided surgical treatment and who regularly attended check-ups to examine the efficacy and results of arthroscopy-aided treatment for collateral ligament injury of the metacarpophalangeal joint. Material and Methods: The study assessed fracture healing, joint movement angles and complications of 11 patients who attended our hand surgery department from December 2015 to April 2018 who had ulnar or radial collateral ligament injury of the metacarpophalangeal joint with accompanying osteochondral avulsion fracture repaired with the aid of arthroscopy with at least 1 year of continuous attendance at check-ups. Results: Four patients had 1st proximal finger avulsion fracture accompanying ulnar collateral ligament injury, four patients had 2nd proximal finger avulsion fracture accompanying ulnar collateral ligament injury, 1 patient had 4th finger and 2 patients had 5th finger proximal phalanx fractures accompanying radial collateral ligament injury. The patients’ avulsion fractures and ligament injuries healed without problem, 2 patients had limited joint movement angles and 1 patient developed complex regional pain syndrome. Conclusion: It is considered that the results of arthroscopy-aided collateral ligament injury repair and avulsed fragment fixation are good and perfect healing.

In vivo metacarpophalanageal joint collateral ligament length changes during flexion.

We investigated the in vivo length changes of the collateral ligaments of metacarpophalangeal joint during flexion. We obtained computed tomography scans of index, middle, ring and little fingers at 0°, 30°, 60° and 90° of joint flexion from six hands of six healthy adult volunteers. Three of them had their dominant right hand studied, and the other three had their non-dominant left hand studied. We measured and analysed the radial and ulnar collateral ligaments of each metacarpophalangeal joint from the reconstructed images. We found that the dorsal and middle portions of the both radial and ulnar collateral ligament lengthened progressively during digital flexion and reached the maximum at 90° flexion. The length of the volar portion increased from 0° to 30° flexion and then decreased from 30° to 60° flexion, reaching the minimum at 90°. In conclusion, three portions of collateral ligaments on both sides of the metacarpophalangeal joint have variable length changes during flexion, which act to stabilize the joint through its flexion arc.

Free Osteoarticular Metatarsal Transfer for Giant Cell Tumor of Metacarpal—a Surgical Technique

BackgroundGiant cell tumor is a relatively uncommon tumor of bonesaccountingfor5%ofalltheprimarybonetumors.Inthesmallbones of hands it occurs even more rarely. Only 2–5% of allthegiantcelltumorshavebeenreportedtoaffectthehandandmetacarpal involvement is much less common than aphalangeal one [1–4]. The tumor occurring at this sitecommonly presents at an advanced stage and is associatedwith more bony destruction thereby complicating treatment[5–8]. Also these are associated with higher rate ofrecurrence [2]. The various treatment modalities describedare curettage with or without bone grafting, en bloc resectionand reconstruction and ray amputations [2] . We heredescribe a case of successful transplantation of 4th metatarsalalong with its osteo-articular ligamentous complex to replacethe 5th metacarpal bone which was the site of tumor. Thisenabled us to preserve the full function of the metacarpo-phalangeal joint by a relatively simple technique.Case PresentationA 25 year old female patient presented to us with a 8-monthhistory of pain and progressive swelling of the right littlefinger metacarpal. She did not sustain any kind of trauma orsuffer any febrile illness during this period. The patient wasin good general condition with normal systemic examina-tion. Local examination revealed a fusiform, non tenderswelling in the area of 5th metacarpal (Fig. 1).Theoverlying skin was free without any sign of inflammation.Movements of the adjoining joint were full in range andwere painless. A radiograph of the hand showed anexpansile, lytic lesion in the diaphyseal region with paperthin cortex of right 5th metacarpal extending up to thesubchondral bone. There was breach in the ulnar side ofcortex. (Figure 2). A radiograph survey of the skeletonshowed no other lesions. Provisional diagnosis of giant celltumour was made and diagnosis confirmed with corebiopsy.Surgical TechniqueEnbloc resection of tumor was done by dorsal approach(Fig. 3a). Whole of the capsule and collateral ligaments ofmetacarpo-phalangeal joint were preserved while excisingthe tumor (Fig. 3b). Disarticulation was done at the level ofcarpo-metacarpal joint. 4th metatarsal was harvested fromthe foot along with capsule and collateral ligaments of itsmetatarso-phalangeal joint. Metatarsal was osteotomisedproximally at a level, according to the pre-operativeplanned length, desired at the recipient site. The capsuleand ligaments of the transferred metatarsal were sutured tothe corresponding capsule and ligaments at the recipientsite, to reconstruct metacrpo-phalangeal joint (Fig. 3c, d).

Outcomes after repair of subacute-to-chronic grade III metacarpophalangeal joint collateral ligament injuries in fingers are suboptimal.

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. 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. 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). 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.

Study of length changes in the collateral ligament during movement of the metacarpophalangeal joint

Objective To investigate changes in collateral ligament length during flexion and extension of the metacarpophalangeal joint (MCJ) of the four fingers. Methods Spiral CT scans of the MCJ of the index, middle, ring and little fingers were obtained from 6 volunteers. Images from the mid-metacarpal to midproximal phalanx were acquired while the MCJ moved from 0° of flexion to 90° of flexion with 30° inerements.Changes in length of the collateral ligament of MCJ of each individual finger during MCJ movement were analyzed by software processing after three-dimensional image reconstruction of bone structures were obtained. Results During flexion of the MCJ the dorsal bundle of the ulnar and radial collateral ligaments lengthened, while the volar bundle shortened. The length of the middle bundle did not change significantly. Conclusion During MCJ flexion and extension, the collateral ligaments are in a state of tension. However tension in different portions of the ligament varies. There are two main relative movements during MCJ flexion: lengthening of the dorsal bundle of the collateral ligament results in increased tension and shortening of the volar bundle results in decreased tension. The middle bundle always maintains proper tension, restricting and regulating the movement of the joint. Key words: Metacarpophalangeal joint; Collateral ligaments; Movement; Length changes; In vivo study

Reconstruction of the Hypoplastic Thumb

Thumb hypoplasia is characterized by diminished thumb size, metacarpal adduction, metacarpophalangeal joint instability, thenar muscle hypoplasia or aplasia, extrinsic tendon dysplasia, and in the most severe cases, carpometacarpal joint instability or thumb aplasia. Severe thumb hypoplasia and aplasia are best treated by thumb ablation and pollicization of the index finger. Less severe thumb hypoplasia can be reconstructed by a combination of soft tissue release, first web space local flap coverage, metacarpophalangeal joint collateral ligament and capsule reconstruction, extrinsic tendon tenolysis, and muscle or tendon transfers.

Closed rupture of the deep transverse metacarpal ligament: Diagnosis and management

Closed rupture of the deep transverse metacarpal ligament (DTML) is an unusual injury. We have managed 2 patients with closed rupture of the DTML between the ring and small fingers resulting from crush injuries to the hand. Both patients presented with painful ulnar deviation of the small finger with extension. The diagnosis was confirmed by exploration through a volar incision. Repair of the ligament with use of the adjacent A1 pulleys to butress the repair was successful in both patients and restored a painless finger flexion-extension arc. Closed rupture of the DTML can be confused with a metacarpophalangeal joint collateral ligament rupture due to the characteristic deviation of the small finger.

Buddy strapping of mismatched fingers: The offset buddy strap

Strapping or taping one finger to an adjacent finger is indicated for several conditions. In stable proximal and middle phalangeal fractures, buddy taping allows early protected range of motion. It is also recommended for the treatment of proximal interphalangeal (PIP) joint dislocations and collateral ligament injuries after a period of immobilization. 1 The technique is also useful in the care of metacarpophalangeal joint collateral ligament injuries and for sagittal band injuries of the extensor mechanism. Buddy taping is also used for mild PIP joint stiffness where motion is desired so that the adjacent finger pulls the affected finger along with it. Finally, strapping is useful where some protection is needed by keeping the injured finger close to the normal finger and out of harm's way. A buddy strap is two layers of Velcro, each with a hook and loop piece connected near one end to create a hinge. There are two short Velcro hook tabs on one end and two longer Velcro loop straps on the other. Velcro buddy straps are available in half-inch and 1-inch widths. The half-inch straps can be used for strapping fingers together where the phalanges are evenly matched side by side. The problem occurs when taping the little finger to the ring finger, because the middle phalanx of the little finger does not match with the middle phalanx of the ring finger. For strapping the middle phalanges of the little and ring fingers, the 1-inch buddy strap can be modified as follows. The buddy strap is placed on a flat surface. The upper layer of the strap is cut down the midline longitudinally through both the long loop strip and short hook tab, leaving the hinge intact. A half-inch piece of the hook and loop is removed on the same side. The buddy strap is turned upside down and a half inch of the contralateral side is removed. The modified offset buddy strap will now have two half-inch straps that do not overlap but are adjacent, or offset. Thus there will be one portion that loops around the middle phalanx of the little finger and the other, offset portion, that fits around the middle phalanx of the ring finger (Fig. 1). An additional unmodified strap can be used around the proximal phalanges for additional support (Fig. 2). The senior author (G.R.) has used this offset buddy strap technique for several years and has been

Injury to the Collateral Ligaments of the Metacarpophalangeal Joints of the Fingers

PG Harris, JF Mosher. Injury to the collateral ligaments of the metacarpophalangeal joints of the fingers. Can J Plast Surg 1994;2(3): 125-129. Injury to the collateral ligaments of metacarpophalangeal (mcp) joints of the fingers has not been given much attention in the literature compared with the more frequently encountered lesion involving the thumb (‘game keeper's’ or ‘skier's’ thumb). Nevertheless, such lesions can result in significant disability if not appropriately treated. To prevent this, awareness of the pathology is required. Pain and lateral instability at the mcp joints may be the only signs. The anatomical lesions vary in sites. Instability to laterally directed stress in full mcp flexion is diagnostic. Most lesions heal with corrective immobilization with the mcp joint at 40° or 45° and ‘buddy taping’ of the fingers. Surgery, through a dorsal approach, is required in cases of rotated or significantly displaced bony attachment and in chronic instability.

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

Static and dynamic procedures have been described for reconstruction of chronic instability of the ulnar collateral ligament of the thumb metacarpophalangeal joint. This study presents a technique of ligament replacement utilizing a free tendon graft passed through two gouge tracks in the proximal phalanx and one in the metacarpal in a manner that closely approximates normal anatomy. We retrospectively reviewed 26 patients who underwent replacement. The follow-up period averaged 4.5 years. In 24 of 26 cases the joint was rendered stable by the replacement and the patient was relieved of pain. Eighty-five percent of the arc of motion was maintained. Postoperative key pinch measured 20 lb. on the operated side compared to 21 lb. on the unoperated side. Results were excellent in 20 patients, good in 4, and fair in 2. This technique successfully restores stability to the ulnar collateral ligament of the thumb metacarpophalangeal joint, diminishes pain and weakness with minimal loss of motion, and holds up over time.

Reinsertion of the ruptured ulnar collateral ligament of the metacarpophalangeal joint with an absorbable self-reinforced polylactide tack

70 patients with total avulsion or rupture of the ulnar collateral ligament of the first metacarpophalangeal joint were treated surgically, using an absorbable self-reinforced poly-L-lactide mini-tack placed through the ligament and a channel in the base of the proximal phalanx. The device stabilized the joint immediately, and 69 ligaments remained stable at 6 months. The subjective result was good or satisfactory in 66 of the cases. One case needed further surgery for pain in the scar and another developed local infection 9 months post-operatively. On the basis of these findings, the new absorbable fixation method seems to be a suitable method for clinical use.

Biomechanical study of tendon excursion of thumb muscles related to interphalangeal and metacarpophalangeal joint motion.

A biomechanical study of tendon excursion versus interphalangeal and metacarpophalangeal (MCP) joint motion relationships on extrinsic and intrinsic thumb muscles has been carried out. Continuous recording of excursion related to joint motion was obtained using a rotary potentiometer and an electrogoniometer. Functional activities of individual muscles were defined based on the excursion data. Moment arms of tendons were also derived. Flexor pollices longus and extensor pollices longus (EPL) tendons have a constant and linear relationship with flexion of the MCP joint. Extensor pollices brevis and flexor pollices longus contribute minimally in abduction-adduction. Extensor pollices longus is a secondary adductor of the joint. Abductor pollices brevis and adductor pollices transverse head are important in dynamic stabilization of the MCP joint and to keep EPL tendon in proper position through the balance of dorsal aponeurosis. This information enables pre-operative planning for functional reconstruction of the thumb, such as in tendon transfers, opponensplasty. MCP joint collateral ligament reconstruction and post-operative management after flexor tendon repair.

Shearing fractures associated with rupture of ulnar collateral ligament of metacarpo-phalangeal joint of thumb

In connexion with rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb a fragment of bone can be sheared off from either the ulnar part of the base of the phalanx or the palmar part of the radial condyle of the metacarpal head, or from both. Five illustrative cases are reported, and diagnosis and treatment are discussed.

Rupture of the collateral ligament of the metacarpo-phalangeal joint of the thumb.

Rupture of the collateral ligament of the metacarpo-phalangeal joint of the thumb.