Bandplastik bei Instabilität des Sattelgelenks

Langer, Martin; Wieskötter, Britta; Herrmann, Ken; Oeckenpöhler, Simon

doi:10.1007/s00064-015-0418-4

Cited by 18 publications

(17 citation statements)

References 26 publications

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“…A significant improvement of ligament laxity was observed, leading to the conclusion that the Arthrex Mini TightRope provides a good stabilization without compromising range of motion. Finally, Langer et al used a technique with an APL strip looped through a trapezium bone tunnel [3]. Among 24 patients, only one case of recurrent instability occurred.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical findings of instability of the CMC 1 joint include pain, functional limitations, subluxation and loss of strength, most commonly exacerbated by the performance of a pinch grip. Laxities of ligaments located at the basal joint of the thumb cause dorso-radial translation at the base of the metacarpal 1, which seems to be one of the main effectors of osteoarthritis (OA) [3]. There seems to be an association between joint hypermobility caused by laxities of ligaments and the presence and severity of CMC 1 OA [4].…”

Section: Introductionmentioning

confidence: 99%

“…In 1973, Eaton and Littler originally proposed the technique of ligament reconstruction involving the weaving of a slip of the flexor carpi radialis (FCR) through the first metacarpal and around the abductor pollicis longus (APL) and FCR tendon [6]. One of the more recently reported surgical approaches is the reduction of the CMC 1 joint, followed by transosseous ligament reconstruction using a distal pedicled tendon strip from the APL muscle to achieve a satisfactory stability of the joint [3].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability

Stauffer

Schwarz

Uranyi

et al. 2019

Arch Orthop Trauma Surg

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Introduction Instabilities of the thumb carpometacarpal (CMC) joint, caused by idiopathic ligamentous hyperlaxity, trauma or other conditions may lead to pain, functional impairment and eventually osteoarthritis. Several techniques have been described to enhance stability of the CMC 1. The aim of this study was to evaluate postoperative outcomes after CMC 1 joint stabilization using a soft-tissue procedure in patients with chronic instability. Materials and methods This study was designed as a retrospective study with a single follow-up visit after a minimum of 1 year postoperatively. All patients who underwent stabilization of the CMC 1 with an abductor pollicis longus (APL) tendon strip for chronic, habitual instability were reassessed using clinical examination, dedicated outcome scores [Visual Analogue Scale (VAS); The Disability of the Arm, Shoulder and Hand (DASH) score; Nelson score; Kapandji opposition score], grip and pinch strength measurements, and radiographic examination. Results 12 patients (15 operated thumbs) with a mean age at surgery of 23.2 (± 9.3) years were included after a mean followup period of 3.5 (± 1.3) years. The postoperative outcomes indicated excellent results, with a mean DASH score of 13.3 (± 11.3), VAS 1.1 at rest (and 2.8 during stress) and Nelson score of 87.7 (± 11.3). Postoperative grip, pinch strength and passive stability were not significantly different between operated and non-operated sides (p = 0.852; p = 0.923 and p = 0.428, respectively). We observed one case of recurrent instability besides no other complications. However, patients with trapezium hypoplasia (5 of 12) were more prone to signs of radiographic instability during stress testing. Conclusions Thumb carpometacarpal stabilization with an APL tendon strip yielded excellent clinical outcomes and low morbidity in the mid-term. However, long-term follow-up is needed to assess specifically whether patients with trapezium hypoplasia may be more prone to clinical symptom recurrence than those with normal anatomy. Level of evidence Level IV

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability

Stauffer

Schwarz

Uranyi

et al. 2019

Arch Orthop Trauma Surg

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“…22,23 Our proposed ligament reconstruction technique specifically focuses on restoring the primary stabilizers of the CMC-I joint, with the aim of minimizing the risk of postoperative complications similar to those of other established CMC-I ligament reconstruction approaches. 2,[24][25][26] Compared with the operative technique described herein, the standard technique described by Eaton-Littler 9,10 is performed by a larger exposure, detachment of the thenar muscles from the volar aspects of trapezium, and exposure and longitudinal sectioning of the fibro osseous tunnel for the flexor carpi radialis tendon at the level of the trapezium. These surgical steps can be technically demanding and can unfortunately lead to complications such as sensory problems from the area supplied by the palmar cutaneous branch of the median nerve which passes in or near the operating field, pain in the area of the reattached thenar muscles and rarely distal flexor carpi radialis tendon rupture.…”

Section: Discussionmentioning

confidence: 99%

First Carpometacarpal Joint Instability: Dorsal Ligament Reconstruction

Zeba¹,

Horváth

Wallmon³

2020

Techniques in Hand &Amp; Upper Extremity Surgery

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The first carpometacarpal (CMC-I) joint has an elaborate ligamentous support. Recent evidence has demonstrated that the dorsal ligament group is imperative for joint stability and that CMC-I joint instability may occur as a consequence of trauma and ligamentous laxity, and other conditions, with possible CMC-I subluxation and the development of osteoarthritis. Although various surgical techniques have been introduced for the treatment of ligamentous CMC-I instability, the Eaton-Littler reconstruction has been regarded as the gold standard. It is widely accepted that impaired hand function may still be present following the reconstruction of the CMC-I joint ligaments, demonstrating the existing limitations of current surgical techniques. In this paper, a novel extra-articular technique relating to CMC-I joint instability and focusing on the dorsal ligament group is described. A graft taken from the abductor pollicis longus tendon is utilized to reconstruct the dorsal radial ligament and posterior oblique ligament. This technique may provide a less invasive alternative than the gold standard procedure and the hypothesis is that it will lead to a better outcome.

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“…The amount of force measured at the CMC joint with pinch is 12 times higher than at the index/thumb tips 3 . If left unaddressed, repeated abnormal joint loading can result in the development of synovitis, metacarpal subluxation, cartilage injury, and ultimately arthritis 4–7 …”

mentioning

confidence: 99%

Thumb Carpometacarpal Stabilization With a Dorsal Capsule Repair Augmented With an Internal Brace

Kronlage

Whitaker

2023

Techniques in Hand &Amp; Upper Extremity Surgery

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Optimal surgical treatment of first carpometacarpal joint instability remains a subject of debate. Consensus on thumb carpometacarpal stability originating with the dorsoradial ligamentous complex has shifted reconstruction techniques towards stabilization dorsally. We describe a dorsal stabilization technique with internal brace augmentation of the dorsoradial ligamentous complex. A single fellowship-trained hand surgeon treated 10 women, average age 34 years (range, 21 to 52 y) and 1 man, age 34 years, between 2019 and 2022. Average patient follow-up was 2 years. Patient satisfaction was high. Further trials are needed to determine whether the procedure will prevent or delay the presentation of thumb carpometacarpal arthrosis.

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Bandplastik bei Instabilität des Sattelgelenks

Cited by 18 publications

References 26 publications

Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability

Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability

First Carpometacarpal Joint Instability: Dorsal Ligament Reconstruction

Thumb Carpometacarpal Stabilization With a Dorsal Capsule Repair Augmented With an Internal Brace

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