Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Surgical techniques and a review of 70 patients

Abstract

We report the use of a free tendon graft in 70 patients to repair lesions of the capsuloligamentous complex of the metacarpophalangeal joint of the thumb. Of these 37 had a lesion of the ulnar collateral ligament, 18 of the radial collateral and 1 1 of the volar plate. Four patients had combined lesions. We outline our techniques and review 51 of the patients. Of those 47 (92%) were satisfied, and all but one had regained full stability. Pinch grip strength was normal in 48. About one-third of the patients had some loss of fiexion/extension; this was seldom noticed by the patients and caused no significant disability. Free tendon graft reconstruction is indicated for severe fresh lesions, for old lesions with chronic disability and for lesions which have not responded to conservative management.

Reconstruction of the ulnar collateral ligament of the thumb metacarpophalangeal joint: A cadaver study

“…1,2,[11][12][13][14][15][16][17][18][19][20][21] In contrast to the predictable recovery of function after acute repair, the poorer tissue quality seen in chronic injuries leads to a higher frequency of recurrent instability. Although small numbers have been reported, the long-term integrity is restored in 50% 1 to 75%, 19 with diminished recovery of pinch strength.…”

“…Clinical results after these reconstructions range from 70% to 92% restoration of joint stability and strength, with an average loss in motion of 20°at the MCP joint. 1,[11][12][13][14][15]20,21 Most of these reconstructive techniques, however, use tissue configurations that do not mimic the native anatomy and rely on fixation that does not allow early motion of the MCP joint. Biomechanical studies of acute UCL repair show that nonanatomic restoration of the phalangeal insertion leads to restricted MCP flexion.…”

“…The clinical results of these interventions vary, ranging from 50% to greater than 90% restoration of joint stability. 1,3,[11][12][13][14][15][16][17][18][19][20][21] The biomechanical characteristics of the native and acutely repaired UCL have been described. 22 The purpose of this study was to compare the stiffness and strength of the native UCL with the characteristics of the ligament reconstruction techniques described by Strandell, 11 Osterman et al, 12 Fairhurst and Hansen, 13 and a modification of the procedure by Glickel et al 14 We hypothesized that none of the ligament reconstructions would approximate the stiffness and strength of the native UCL.…”

Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries: A Biomechanical Simulation Study of Four Static Reconstructions

“…1-3 Treatment options vary widely but include immobilization, direct repair, dynamic tendon transfers, static ligament reconstructions, and arthrodesis, among others. [1][2][3][4][5][6][7][8][9][10] Static ligament reconstruction with free tendon grafting is a commonly used method to treat chronic instability of the thumb metacarpophalangeal (MCP) joint. Surgical goals are to restore normal stability and range of motion.…”

Fixation of Tendon Grafts for Collateral Ligament Reconstructions: A Cadaveric Biomechanical Study

“…[1][2][3][4][5][6][7] In an effort to avoid such outcomes the reconstruction of the collateral ligament may be performed with a tendon graft. [7][8][9][10][11][12][13][14] In one method a graft is looped through a bone tunnel in the proximal aspect of the proximal phalanx and both free limbs are passed through a bone tunnel in the distal aspect of the metacarpal. Fixation of the free limbs of the tendon graft may be achieved by tying sutures extending from the free tendon ends over a button with soft tissue interposed.…”