Long-term Outcomes Following Vickers Ligament Release and Growth Modulation for the Treatment of Madelung Deformity

Abstract

Background: Madelung deformity arises from a partial distal radial growth disturbance in combination with an abnormal hypertrophic ligament spanning the volar radius and carpus, termed, the Vickers ligament. The purpose of this study is to report long-term clinical and radiographic outcomes following Vickers ligament release and distal radial physiolysis in a population of skeletally immature patients with symptomatic Madelung deformity. Methods: Medical records were retrospectively reviewed of patients with Madelung deformity surgically treated between 1994 and 2005. All eligible patients who underwent a Vickers ligament release and distal radial physiolysis were contacted and invited to return to the clinic for follow-up. Results: Six patients (8 wrists) with Madelung deformity underwent Vickers ligament release and distal radial physiolysis. All were white females with a mean age at initial presentation of 11.4 years (10 to 12.8 y). Mean age at the time of initial surgery was 12.0 years (10.0 to 14.5 y). The median follow-up time was 10.6 years (5.8 to 21.9 y) and the average age at last follow-up was 23.1 years (17.5 to 32.2 y). Pain alone or in combination with concerns for deformity was the chief complaint in 6 of 8 of the wrists. At 1 year of clinical follow-up, 7 of 8 wrists were reported to be pain-free, and 6 of the 8 were noted to be completely pain-free at last follow-up. Motion in flexion, extension, pronation, supination, radial, or ulnar deviation was similar between the preoperative status and long-term follow-up. The average preoperative ulnar tilt was 35.1 degrees (SD: 8.5 degrees), average preoperative lunate subsidence was 1.9 degrees (SD: 1.8 degrees), and average preoperative palmar carpal displacement was 21.9 degrees (SD: 2.9 degrees). At the final follow-up, there was a large progression in lunate subsidence, but minimal change in ulnar tilt and palmar carpal displacement. At last clinical follow-up, 2 of the 6 patients had undergone a subsequent procedure including 1 radial dome osteotomy and 1 ulnar shortening osteotomy. Conclusion: In the skeletally immature patient population with Madelung deformity with growth potential remaining, distal radial physiolysis and Vickers ligament release is associated with relief of pain, preservation of motion, and, a reasonable rate of reoperation. Type of Study: This was a therapeutic study. Level of Evidence: Level II.

The prevalence of Vickers’ ligament in Madelung’s deformity: a retrospective multicentre study of 75 surgical cases

“…While our cohort of patients included some older patients for whom a corrective osteotomy was performed, the presence or absence of Vickers' ligament might be of interest in children 8 to 10 years old for whom a physiolysis might prevent the aforementioned deformation. Although various studies have reported good clinical and radiographic outcomes after Vickers' ligament release/un-tethering with physeal resection or radial dome osteotomy (Del Core et al, 2020;Otte et al, 2019;Steinmann et al, 2013), these and other studies have failed to report the presence of this particular structure. Moreover, the presence of a Vickers' ligament might cause a more severe course of the deformity's progression.…”

Radial Osteotomy With Callus Distraction for the Correction of Severe Madelung Deformity

“…Some benefits of these procedures have been reported; however, simultaneous ulnar shortening or additional secondary surgeries were needed due to residual deformities. [2][3][4][5] It is difficult to predict how much growth can be regained only by these procedures because the influence on the growth plate starts at birth. Presently, the treatment modality for Madelung deformity is quite different from that for posttraumatic growth retardation.…”

“…Consequently, various surgical interventions, such as corrective osteotomy, Vickers ligament release, and ulnar shortening, have been attempted. [1][2][3][4][5][6][7][8][9] However, all these procedures can only reduce the severity of the deformity and pain without preventing the development of physeal disorders. Herein, we report a case of an adolescent patient with severe forearm deformity in whom we performed callus distraction with corrective osteotomy.…”

3D MRI of the Hand and Wrist: Technical Considerations and Clinical Applications

“…Identification of Vickers ligament is consequently crucial to growth modulation and improvement of symptoms in this cohort of patients. 45 Similarly, for preoperative planning of syndactyly and polydactyly correction, assessment of adjacent soft tissue structures, including tendons, ligaments, pulleys, and volar plates, aids the surgeons in determining which bony structures to sacrifice and which need to be reconstructed and reattached.…”