Rupture of the Radial Collateral Ligament of the Index Metacarpophalangeal Joint: Diagnosis and Surgical Treatment

Kang, Lana; Rosen, Alan; Potter, Hollis G.; Weiland, Andrew J.

doi:10.1016/j.jhsa.2007.04.008

Cited by 57 publications

(53 citation statements)

References 14 publications

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“…Fortunately, repair was possible because there was no Stener-type lesion and enough substance of the ligament remained. A similar observation was found in a 12-patient study of index RCL tears of the MCP joint with no presence of Stener-type lesions, with mean duration from injury to surgery of 7 months (range, 0.5-37.5 m) [17]. This study and our case both suggest that good results may be attainable despite late repairs.…”

Section: Discussionsupporting

confidence: 91%

“…In spite No discernable endpoint to ulnarly applied stress This grading system has been published in the text of Gatson et al [4] a Laxity was measured by testing the involved index finger in full flexion with ulnar directed stress and comparing it to the contralateral digit of this result, we continue to advocate the need for an early diagnosis and treatment to allow for a better outcome [10]. The RCL rupture was repaired with a Mitek bone suture anchor, which has been used in previous cases of repair of the collateral ligaments [10,17,18,21,24,29,37]. This anchor is a titanium alloy with its prongs composed of titanium and nickel [16].…”

Section: Discussionmentioning

confidence: 99%

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Index Radial Collateral Ligament Repair with Titanium Mini-Suture Anchor: Osteolysis Complication of an Underreported Injury

Mirza

Reinhart

Bove

2009

Hand (New York, N,Y.)

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We are reporting on a case of an index radial collateral ligament tear repaired with a titanium Mitek bone suture anchor. The development of cystic radiographic changes and increased pain and weakness led to suture anchor removal at 10 months post-repair. Periprosthetic osteolysis due to titanium-induced osteoclastogenesis and micromotion was suspected to be the cause. This case report provides a dual focus by stressing the importance of the diagnosis and treatment of this underreported ligament tear and highlighting our osteolysis complication via the mechanism of titanium-induced osteoclastogenesis for future therapeutic preventive measures.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Index Radial Collateral Ligament Repair with Titanium Mini-Suture Anchor: Osteolysis Complication of an Underreported Injury

Mirza

Reinhart

Bove

2009

Hand (New York, N,Y.)

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“…14,15,[17][18][19][20] Anatomic features that predispose the small finger RCL to injury compared with the other digits include its position as a border digit and the absence of a deep transverse metacarpal ligament on its radial side. 16,18 The etiology is typically traumatic and the result of an ulnarly and dorsally directed force leading to rupture of the RCL. Presenting symptoms typically include pain, dysfunction, and instability.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16][17] Of these non-thumb digits, the radial collateral ligament (RCL) of the small finger is a frequent site of injury. Injury most commonly occurs as a result of forced ulnar and dorsal deviation leading to RCL from the metacarpal or phalangeal attachment site.…”

mentioning

confidence: 99%

Arthroscopic Repair of Collateral Ligaments in Metacarpophalangeal Joints

Abernathie¹,

Lovy²,

Koehler³

et al. 2015

Arthroscopy Techniques

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Although typically reported in thumb and small fingers, collateral ligament ruptures of the metacarpophalangeal (MCP) joints have been described in all digits. Traditional open repair requires a dissection that violates the sagittal band and may result in increased scarring and decreased hand function. Arthroscopic repair of MCP collateral ligaments has not been previously described. We present a new technique for repairing MCP collateral ligaments arthroscopically.A dvances in technology and improvement in arthroscopic technique have made it possible to access joints as small as the interphalangeal joints. However, since Chen's initial report on metacarpophalangeal (MCP) arthroscopy in 1979, 1 there have been fewer than 20 articles describing the technique and indications for MCP arthroscopy. Described uses and indications for MCP arthroscopy have included foreign-body debridement, rheumatoid synovectomy, assistance with fracture dislocation, and ulnar collateral ligament repair in the thumb. [2][3][4][5][6][7][8][9][10][11][12][13] There are no previous reports of non-thumb arthroscopic collateral ligament repair.Although most of the literature has focused on ulnar collateral ligament injury of the thumb, collateral ligament injuries have been described in all digits.14-17 Of these non-thumb digits, the radial collateral ligament (RCL) of the small finger is a frequent site of injury. Injury most commonly occurs as a result of forced ulnar and dorsal deviation leading to RCL from the metacarpal or phalangeal attachment site.14,18 After traumatic injury, patients with RCL injuries to the small finger can clearly be identified by the abducted resting posture and notable laxity on examination.19 Clinically, the injury causes frequent "snagging" of the finger and repeated injury, even with simple tasks such as reaching into one's pocket.Traditional open repair of this ligament requires an incision violating the sagittal band 19 and may have the potential for extensor tendon subluxation, discomfort, adhesion formation, and difficulty regaining a normal range of motion. We present a new method for arthroscopic collateral ligament repair potentially limiting the possible complications from open repair (Figs 1-3). TechniqueThe surgical technique is demonstrated in Video 1. The patient is placed in the supine position, and general or regional anesthesia is established. A tourniquet is placed around the upper arm. Preparation and draping are performed in standard fashion, and a finger trap is placed on the affected finger, along with Mastisol (Eloquest Healthcare, Ferndale, MI), to help prevent slippage. We then suspend the finger from the traction tower and set it to 8 to 10 lb of traction. The extremity is exsanguinated with an Esmarch bandage and tourniquet inflated to 250 mm Hg.A palpable depression is notable at the joint level with the extensor tendon palpable in the midline. The camera portal is placed several millimeters from the midline on the side contralateral to the injury to avoid injury to the ce...

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“…En aquellos casos en que hay una marcada inestabilidad, afectando sobre todo al índice o al quinto dedo nos podemos plantear una reparación quirúrgica mediante reinserción del ligamento. Asimismo hay que plantearse el tratamiento quirúrgico en aquellos casos en que existe un arrancamiento óseo que afecte a la superficie articular en más de un 25%, o en aquellos casos en los que hay una separación de más de 3mm 4,[9][10][11][12][13] .…”

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Lesiones de los ligamentos de los dedos

Guitián¹

2010

Rev Iberoam Cir Mano

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L as lesiones de los ligamentos de los dedos son lesiones frecuentes en la patología de la mano, que habitualmente requieren un tratamiento ortopédico, y que a su aparente banalidad se contrapone la frecuente existencia de secuelas dolorosas o de rigidez articular. Las lesiones cápsulo-ligamentosas digitales predominantes son los esguinces y luxaciones de las articulaciones interfalangicas proximales (IFP) de los dedos largos y de la articulación metacarpofalángica (MCF) del pulgar. A pesar de su frecuencia no son demasiadas las referencias bibliográficas sobre dicha patología. Realizada una búsqueda en el Medline de los últimos cinco años hemos encontrado 32 referencias para el término "finger ligaments injuries" y 12 referencias para "Stener lesión".Lo fundamental para establecer el tipo de tratamiento, quirúrgico u ortopédico nos vendrá dado por la estabilidad articular. Esta debe ser estudiada tanto de forma pasiva como activa, y será el conjunto de este estudio con las necesidades de la articulación afecta la que determinará el tipo de tratamiento a instaurar.Como se ha indicado el estudio de la estabilidad articular ha de realizarse tanto en su forma pasiva como en la activa.Estabilidad pasiva: La exploración de la estabilidad lateral y anteroposterior se realiza de forma bilateral, si es necesario bajo anestesia local, comparando la articulación afecta con la contralateral.Estabilidad activa: Capacidad del paciente para repetir una subluxación o luxación. El paciente mueve el dedo en su arco de movilidad habitual, si completa el movimiento sin desplazamiento anómalo el dedo es estable. En caso de redesplazamiento estaremos ante una lesión inestable. LESIONES MCF DE LOS DEDOS LARGOS:RECUERDO ANATÓMICO 1-4Hay una serie de características anatómicas que debemos valorar en cuanto a la estabilidad de estas articulaciones:1º La placa volar (PV) es más gruesa y fuerte en la inserción en la falange que en el metacarpiano. 2º La placa volar (PV) se encuentra reforzada por el ligamento intermetacarpiano transverso profundo (LIT) y la vaina de los flexores (VF) (Figura 1). 3º Los ligamentos laterales (LL) se encuentran más tensos en flexión que en extensión (Figura 2). 4º La articulación es más estable en flexión, permitiendo cierto grado de abducción-aducción en extensión.

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Rupture of the Radial Collateral Ligament of the Index Metacarpophalangeal Joint: Diagnosis and Surgical Treatment

Cited by 57 publications

References 14 publications

Index Radial Collateral Ligament Repair with Titanium Mini-Suture Anchor: Osteolysis Complication of an Underreported Injury

Index Radial Collateral Ligament Repair with Titanium Mini-Suture Anchor: Osteolysis Complication of an Underreported Injury

Arthroscopic Repair of Collateral Ligaments in Metacarpophalangeal Joints

Lesiones de los ligamentos de los dedos

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