Soft Tissue Reinforcement Research Articles

Lateral Malleolar Reconstruction After Distal Fibular Resection

T umors of the distal part of the fibula necessitating resection pose a problem because of the need to reconstruct a stable ankle joint and to obtain coverage of this area. Standard textbook solutions include simple resection of the distal aspect of the fibula including the lateral malleolus, as described by Carnesale1 and later by Norman-Taylor et al.2, and resection of the distal part of the fibula with reconstruction of the lateral malleolus with use of the fibular head, as described by Carrell3, Herring et al.4, and de Gauzy et al.5. An allograft reconstruction has also been described6, as has reconstruction with an iliac crest bone graft7. Other possible techniques, albeit less desirable, are ankle arthrodesis and amputation. Although the textbook techniques are considered to be classics, not many reports have detailed their use and results2-5,8-12. These methods, at least theoretically, have a number of drawbacks. In distal fibular resection without reconstruction, the stabilizing effect of the lateral malleolus is lost. Soft-tissue reinforcement, even when it is possible, cannot fully compensate for the loss of stability13. Thus, the ankle may collapse into valgus and may be unstable in varus. Conversely, when the mortise is reconstructed with use of a proximal fibular (head) graft, the lateral collateral ligament of the knee is affected and the peroneal nerve is endangered14,15. Additionally, the fibular head is not totally congruent with the lateral articular surface of the talus and provides no stabilizing ligament attachments. Ankle arthrodesis might solve the problems of instability, but it limits the ability to walk. Amputation is reserved as a last resort for patients in whom limb-sparing is not feasible. We describe a …

Grade III radial collateral ligament injuries of the thumb metacarpophalangeal joint: Treatment by soft tissue advancement and bony reattachment

Purpose: The purpose of this study is to report the results of intact radial collateral ligament (RCL) soft tissue sleeve advancement with bony reattachment without additional soft tissue reinforcement as the sole surgical repair technique for the treatment of grade III RCL injuries to the thumb metacarpophalangeal (MCP) joint in acute, chronic, and late cases. Methods: During a 20-year period, 38 of 45 patients (84%) with grade III RCL injuries were found to have tears at or adjacent to the metacarpal head (25 patients) or the proximal phalanx (13 patients) and underwent surgical repair at a mean of 10.8 months after injury. Patients were evaluated at a mean follow-up time of 3.8 years (minimum, 1 year), comparing pre- and postoperative standard thumb x-rays, varus (adduction) MCP joint stress x-rays, joint range of motion, pinch and grip strengths, clinical deformity, and subjective symptoms. Results: Thirty-three patients (87%) were symptom free. Thirty-five patients (92%) regained normal pinch and grip strength. Thirty patients (79%) had full range of motion at the MCP joint, and no patient lost any interphalangeal joint motion. No recurrent symptomatic MCP joint instability was noted. Three patients (8%) had mild residual asymptomatic MCP joint volar subluxation. One patient had progression of pre-existing degenerative joint changes. Conclusion: Acute, chronic, and late grade III RCL instability of the thumb MCP joint can be successfully treated in the majority of cases by RCL soft tissue sleeve advancement and bony reattachment alone without the need for other soft tissue reinforcement. (J Hand Surg 2003;28A:14-20. Copyright © 2003 by the American Society for Surgery of the Hand.)