Radial collateral ligament repair of the thumb: long-term outcomes and predictive factors of postoperative deficits.
Metacarpophalangeal joint-1
Radial collateral ligament
Stener lesion
Thumb
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
24
03
2020
accepted:
31
05
2020
pubmed:
6
6
2020
medline:
16
12
2020
entrez:
6
6
2020
Statut:
ppublish
Résumé
The thumb's radial collateral ligament (RCL) plays an important role in stabilizing the first metacarpophalangeal joint (MCP-1). RCL injuries are rare and treatment recommendations are inconsistent in the current literature. The aim of this study was to report on long-term outcomes following surgical repair of thumb RCL tear and to identify prognostic risk factors for treatment failure. Patients with RCL tear from 10/1998 to 10/2019 were included in the present retrospective single center cohort study. In follow-up visits, participants were assessed regarding pain, range of motion and strength as well as with disability of shoulder, arm and hands (DASH), and the Short-Form 36 (SF36) questionnaires. Finally, predictive factors of postoperative deficits were identified. 43 patients fulfilled inclusion criteria. Median age was 43.5 years (range 18-80 years). The most frequent mechanism of injury was a fall or impact. Bony avulsions were identified in 46.5% (20/43). Time from injury to surgery was 12 days (0-276 days). One Stener-like lesion was observed intraoperatively among our patients. After surgical repair, the MCP-1 joint was stable in every patient. Mean time to follow-up was 5.3 years (1 month to 17 years). Persistency of pain in the MCP-1 joint was reported by 11 patients. Postoperative averaged score was 3.75 on DASH and 44.96 on SF36, respectively. The average grip and pinch strength was 32.7 kg and 8.37 kg, respectively. Predictive factors of postoperative deficits were delay of surgery of > 3 weeks (OR 10.72, p 0.017) and palmar subluxation prior to surgery (OR 8.86, p 0.019). Long-term follow-up has proven that surgical repair of RCL enables the patient to regain adequate stability and strength of the MCP-1 joint and minimizes disability. Predictive risk factors of pain persistency after surgery are surgical delay and palmar subluxation of the MCP-1 joint.
Sections du résumé
BACKGROUND
BACKGROUND
The thumb's radial collateral ligament (RCL) plays an important role in stabilizing the first metacarpophalangeal joint (MCP-1). RCL injuries are rare and treatment recommendations are inconsistent in the current literature. The aim of this study was to report on long-term outcomes following surgical repair of thumb RCL tear and to identify prognostic risk factors for treatment failure.
METHODS
METHODS
Patients with RCL tear from 10/1998 to 10/2019 were included in the present retrospective single center cohort study. In follow-up visits, participants were assessed regarding pain, range of motion and strength as well as with disability of shoulder, arm and hands (DASH), and the Short-Form 36 (SF36) questionnaires. Finally, predictive factors of postoperative deficits were identified.
RESULTS
RESULTS
43 patients fulfilled inclusion criteria. Median age was 43.5 years (range 18-80 years). The most frequent mechanism of injury was a fall or impact. Bony avulsions were identified in 46.5% (20/43). Time from injury to surgery was 12 days (0-276 days). One Stener-like lesion was observed intraoperatively among our patients. After surgical repair, the MCP-1 joint was stable in every patient. Mean time to follow-up was 5.3 years (1 month to 17 years). Persistency of pain in the MCP-1 joint was reported by 11 patients. Postoperative averaged score was 3.75 on DASH and 44.96 on SF36, respectively. The average grip and pinch strength was 32.7 kg and 8.37 kg, respectively. Predictive factors of postoperative deficits were delay of surgery of > 3 weeks (OR 10.72, p 0.017) and palmar subluxation prior to surgery (OR 8.86, p 0.019).
CONCLUSION
CONCLUSIONS
Long-term follow-up has proven that surgical repair of RCL enables the patient to regain adequate stability and strength of the MCP-1 joint and minimizes disability. Predictive risk factors of pain persistency after surgery are surgical delay and palmar subluxation of the MCP-1 joint.
Identifiants
pubmed: 32500203
doi: 10.1007/s00402-020-03509-0
pii: 10.1007/s00402-020-03509-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1293-1299Références
Daley D, Geary M, Gaston RG (2020) Thumb metacarpophalangeal ulnar and radial collateral ligament injuries. Clin Sports Med 39(2):443–455
doi: 10.1016/j.csm.2019.12.003
Werner BC, Belkin NS, Kennelly S (2017) Injuries to the collateral ligaments of the metacarpophalangeal joint of the thumb, including simultaneous combined thumb ulnar and radial collateral ligament injuries, in National Football League athletes. Am J Sports Med 45(1):195–200
doi: 10.1177/0363546516660979
Owings FP, Calandruccio JH, Mauck BM (2016) Thumb ligament injuries in the athlete. Orthop Clin North Am 47(4):799–807
doi: 10.1016/j.ocl.2016.06.001
Wang KK, Boyce G, Peters T (2019) Efficacy of primary repair in professional athletes with chronic radial collateral ligament injuries of thumb metacarpophalangeal joint. J Hand Surg Asian Pac 24(2):138–143
doi: 10.1142/S2424835519500176
Jakubietz RG, Erguen S, Bernuth S (2020) An anatomical study on the Stener-type lesion of the radial collateral ligament of the metacarpophalangeal joint of the thumb. J Hand Surg Eur 45(2):131–135
doi: 10.1177/1753193419887344
Nakayama M, Sakuma Y, Tobimatsu H (2020) Recurrent volar dislocation of the metacarpophalangeal joint of the thumb with radial collateral ligament injury: a case report. Int J Surg Case Rep 6(68):96–99
doi: 10.1016/j.ijscr.2020.01.056
Coonrad RW, Goldner JL (1968) A study of the pathological findings and treatment in soft-tissue injury of the thumb metacarpophalangeal joint. J Bone Jt Surg Am 50(3):439–451
doi: 10.2106/00004623-196850030-00001
Camp RA, Weatherwax RJ, Miller EB (1980) Chronic posttraumatic radial instability of the thumb metacarpophalangeal joint. J Hand Surg Am 5(3):221–225
doi: 10.1016/S0363-5023(80)80006-2
McDermott TP, Levin LS (1998) Suture anchor repair of chronic radial ligament injuries of the metacarpophalangeal joint of the thumb. J Hand Surg Br 23(2):271–274
doi: 10.1016/S0266-7681(98)80196-4
Melone CP, Beldner S, Basuk RS (2000) Thumb collateral ligament injuries. An anatomic basis for treatment. Hand Clin 16(3):345–357
pubmed: 10955208
Langer MF, Oeckenpöhler S, Spies CK (2020) Dorsal plate arthrodesis of the thumb metacarpophalangeal joint. Oper Orthop Traumatol 32(1):47–57
doi: 10.1007/s00064-019-0592-x
Durham JW, Khuri S, Kim MH (1993) Acute and late radial collateral ligament injuries of the thumb metacarpophalangeal joint. J Hand Surg Am 18(2):232–237
doi: 10.1016/0363-5023(93)90353-5
Köttstorfer J, Hofbauer M, Krusche-Mandl I, Kaiser G, Erhart J, Platzer P (2013) Avulsion fracture and complete rupture of the thumb radial collateral ligament. Arch Orthop Trauma Surg 133(4):583–588
doi: 10.1007/s00402-013-1701-1
Coyle MP (2003) Grade III radial collateral ligament injuries of the thumb metacarpophalangeal joint: treatment by soft tissue advancement and bony reattachment. J Hand Surg Am 28(1):14–20
doi: 10.1053/jhsu.2003.50008
Catalano LW, Cardon L, Patenaude N, Barron OA, Glickel SZ (2006) Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. J Hand Surg Am 31(1):68–75
doi: 10.1016/j.jhsa.2005.08.013
Avery DM, Inkellis ER, Carlson MG (2017) Thumb collateral ligament injuries in the athlete. Curr Rev Musculoskelet Med. https://doi.org/10.1007/s12178-017-9381-z
doi: 10.1007/s12178-017-9381-z
pubmed: 28133709
pmcid: 5344852
Edelstein DM, Kardashian G, Lee SK (2008) Radial collateral ligament injuries of the thumb. J Hand Surg Am 33(5):760–770. https://doi.org/10.1016/j.jhsa.2008.01.037
doi: 10.1016/j.jhsa.2008.01.037
pubmed: 18590860
Lee S, Yum J, Kim JY (2010) Locking of the metacarpophalangeal joint of the thumb with the radial collateral ligament rupture after stress radiography. Arch Orthop Trauma Surg 130(2):237–239. https://doi.org/10.1007/s00402-009-0933-6
doi: 10.1007/s00402-009-0933-6
pubmed: 19609539
Kim BS, Doermann A, McGarry M (2019) Additional dorsal fibrocartilage repair in a combined radial collateral ligament and dorsal fibrocartilage injury of the thumb metacarpophalangeal joint. Orthopedics 42(2):e268–e272
doi: 10.3928/01477447-20190211-03
Conforto I, Samir C, Chausse F (2019) Comparison of psychometric properties between the Labin, a new electronic dynamometer, and the Jamar: preliminary results in healthy subjects. Hand Surg Rehabil 38(5):293–297
doi: 10.1016/j.hansur.2019.07.009
Rojas EO, Glass N, Owens J et al (2019) Performance of the PROMIS in patients undergoing 3 common elbow procedures. Orthop J Sport Med 7(6):1–5. https://doi.org/10.1177/2325967119852595
doi: 10.1177/2325967119852595
Bernstein DT, McCulloch PC, Winston LA, Liberman SR (2018) Early return to play with thumb spica gauntlet casting for ulnar collateral ligament injuries complicated by adjacent joint dislocations in collegiate football linemen. Hand. https://doi.org/10.1177/1558944718788644
doi: 10.1177/1558944718788644
pubmed: 30073845
Werner BC, Hadeed MM, Lyons ML, Gluck JS, Diduch DR, Chhabra AB (2014) Return to football and long-term clinical outcomes after thumb ulnar collateral ligament suture anchor repair in collegiate athletes. J Hand Surg Am. https://doi.org/10.1016/j.jhsa.2014.06.132
doi: 10.1016/j.jhsa.2014.06.132
pubmed: 25459378
Baschung Pfister P, de Bruin ED, Bastiaenen CHG (2019) Reliability and validity of the German version of the Myositis Activities Profile (MAP) in patients with inflammatory myopathy. PLoS ONE 14(6):e0217173
doi: 10.1371/journal.pone.0217173