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CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2020; 48(02): 101-108
DOI: 10.1055/s-0040-1719014
Original Article | Artículo Original

Percutaneous Reconstruction of the Ulnar Collateral Ligament of the Metacarpophalangeal Joint of the Thumb: Technique and Results

Article in several languages: English | español
Juan Manuel Herrera 
1   Hand Surgery Unit, Centro Privado de Cirugía del Pie y la Mano (CEPYM), Tucumán, Argentina
2   Hand Surgery Unit, Centro Integral de Ortopedia y Traumatología (CIOT), Tucumán, Argentina
,
Lucas Herrera 
2   Hand Surgery Unit, Centro Integral de Ortopedia y Traumatología (CIOT), Tucumán, Argentina
,
Pablo Rotella 
3   Hand Surgery Unit, Instituto Rotella, Tucumán, Argentina
,
Raquel Cantero Téllez 
4   Hand Clinic, Centro Tecan, Universidad de Málaga, Málaga, Spain
,
Jimena Castellanos 
5   Occupational Therapy, Hand therapy, Tucumán, Argentina
,
Fernando Vázquez 
6   Hand Surgery Unit, Clínica Mayo, Tucumán, Argentina
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Abstract

Objectives The present study aims to describe a new percutaneous technique for the reconstruction of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb with a tendon graft, and to evaluate the functional outcomes and stability six months postoperatively.

Material and methods The percutaneous ligamentoplasty technique was performed with a palmaris longus tendon graft and tenodesis screws in 6 patients with ulnar instability of the thumb (> 30° degrees of radial deviation) for more than 6 weeks. Range of motion, grip strength, and pinch strength (lateral/key pinch, tip pinch, and palmar pinch) were assessed in comparison to the contralateral limb, as well as the Quick Disabilities of the Arm, Shoulder and Hand (DASH) score.

Results At 6 months, the joint movement was of 100%, the grip strength was of 94.8%, the key pinch was of 95%, the palmar pinch was of 85.7%, and the tip pinch was of 93.5% compared to the contralateral limb. The internal tilt was of 14° compared to 9° at the contralateral limb. The Quick DASH score decreased from 24.2 to 2.6 points.

Conclusion We devised this versatile surgical procedure to obtain early mobility with the advantages related to the percutaneous techniques.

Keywords

metacarpophalangeal joint - thumb - ulnar collateral ligament - percutaneous


Publication History

Received: 27 July 2020

Accepted: 02 September 2020

Article published online:
24 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Campbell CS. Gamekeeper's thumb. J Bone Joint Surg Br 1955; 37-B (01) 148-149
    CrossrefPubMedGoogle Scholar
  • 2 Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpophalangeal joint of the thumb: a clinical and anatomic study. J Bone Joint Surg Br 1962; 44: 869-879
    CrossrefPubMedGoogle Scholar
  • 3 Lee AT, Carlson MG. Thumb metacarpophalangeal joint collateral ligament injury management. Hand Clin 2012; 28 (03) 361-370 , ix–x DOI: 10.1016/j.hcl.2012.05.024.
    CrossrefPubMedGoogle Scholar
  • 4 Tsiouri C, Hayton MJ, Baratz M. Injury to the ulnar collateral ligament of the thumb. Hand (N Y) 2009; 4 (01) 12-18 DOI: 10.1007/s11552-008-9145-8.
    CrossrefPubMedGoogle Scholar
  • 5 Lark ME, Maroukis BL, Chung KC. The Stener Lesion: Historical Perspective and Evolution of Diagnostic Criteria. Hand (N Y) 2017; 12 (03) 283-289 DOI: 10.1177/1558944716661999.
    CrossrefPubMedGoogle Scholar
  • 6 Glickel SZ, Malerich M, Pearce SM, Littler JW. Ligament replacement for chronic instability of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Hand Surg Am 1993; 18 (05) 930-941
    CrossrefPubMedGoogle Scholar
  • 7 Neviaser RJ, Wilson JN, Lievano A. Rupture of the ulnar collateral ligament of the thumb (gamekeeper's thumb). Correction by dynamic repair. J Bone Joint Surg Am 1971; 53 (07) 1357-1364
    CrossrefPubMedGoogle Scholar
  • 8 Fairhurst M, Hansen L. Treatment of “Gamekeeper's Thumb” by reconstruction of the ulnar collateral ligament. J Hand Surg [Br] 2002; 27 (06) 542-545
    CrossrefPubMedGoogle Scholar
  • 9 Takagi T, Watanabe M. Ulnar Collateral Ligament Reconstruction of Thumb Metacarpophalangeal Joint With Adductor Pollicis Tendon Using the Wide-Awake Approach. J Hand Surg Am 2019; 44 (05) 426.e1-426.e5 DOI: 10.1016/j.jhsa.2018.11.012.
    CrossrefPubMedGoogle Scholar
  • 10 De Giacomo AF, Shin SS. Repair of the Thumb Ulnar Collateral Ligament With Suture Tape Augmentation. Tech Hand Up Extrem Surg 2017; 21 (04) 164-166 DOI: 10.1097/BTH.0000000000000173.
    Google Scholar
  • 11 Wong TC, Ip FK, Wu WC. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumb--minimum 5-year follow-up evaluation. J Hand Surg Am 2009; 34 (02) 304-308 DOI: 10.1016/j.jhsa.2008.10.005.
    CrossrefPubMedGoogle Scholar
  • 12 Selles RW, Zhou C, Kan HJ, Wouters RM, van Nieuwenhoven CA, Hovius SER. Percutaneous Aponeurotomy and Lipofilling versus Limited Fasciectomy for Dupuytren's Contracture: 5-Year Results from a Randomized Clinical Trial. Plast Reconstr Surg 2018; 142 (06) 1523-1531 DOI: 10.1097/PRS.0000000000004982.
    CrossrefPubMedGoogle Scholar
  • 13 del Piñal F, Moraleda E, Rúas JS, de Piero GH, Cerezal L. Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am 2015; 40 (04) 692-700 DOI: 10.1016/j.jhsa.2014.11.023.
    CrossrefPubMedGoogle Scholar
  • 14 Uçar BY. Percutaneous surgery: a safe procedure for trigger finger?. N Am J Med Sci 2012; 4 (09) 401-403 DOI: 10.4103/1947-2714.100988.
    CrossrefPubMedGoogle Scholar
  • 15 Geissler WB. Cannulated percutaneous fixation of intra-articular hand fractures. Hand Clin 2006; 22 (03) 297-305 , vi
    CrossrefPubMedGoogle Scholar
  • 16 Greg Merrell and Joseph F. Slade. Dislocations and Ligament Injuries in the Digits. In: Green DP, Wolfe SW. Green's Operative Hands Surgery 6. ed. London: Churchill Livingstone; 2010: 2392
    Google Scholar
  • 17 Glickel SZ. Thumb metacarpophalangeal joint ulnar collateral ligament reconstruction using a tendon graft. Tech Hand Up Extrem Surg 2002; 6 (03) 133-139
    CrossrefPubMedGoogle Scholar
  • 18 Wehbé MA. Tendon graft donor sites. J Hand Surg Am 1992; 17 (06) 1130-1132
    CrossrefPubMedGoogle Scholar
  • 19 Lee SK, Kubiak EN, Liporace FA, Parisi DM, Iesaka K, Posner MA. Fixation of tendon grafts for collateral ligament reconstructions: a cadaveric biomechanical study. J Hand Surg Am 2005; 30 (05) 1051-1055
    CrossrefPubMedGoogle Scholar
  • 20 Lee SK, Kubiak EN, Lawler E, Iesaka K, Liporace FA, Green SM. Thumb metacarpophalangeal ulnar collateral ligament injuries: a biomechanical simulation study of four static reconstructions. J Hand Surg Am 2005; 30 (05) 1056-1060
    Google Scholar
  • 21 Baskies MA, Tuckman D, Paksima N, Posner MA. A new technique for reconstruction of the ulnar collateral ligament of the thumb. Am J Sports Med 2007; 35 (08) 1321-1325
    CrossrefPubMedGoogle Scholar
  • 22 Rettig A, Rettig L, Welsch M. Anatomic reconstruction of thumb metacarpophalangeal joint ulnar collateral ligament using an interference screw docking technique. Tech Hand Up Extrem Surg 2009; 13 (01) 7-10 DOI: 10.1097/BTH.0b013e318184185e.
    Google Scholar
  • 23 Jimenez ML, Hioe SD, Kachooei AR, Shearin JW, Jones CM, Rivlin M. Single-Bundle vs Double-Bundle (Anatomical) Reconstruction of the Thumb Ulnar Collateral Ligament: Biomechanical Study. Hand (N Y) 2019; 14 (04) 483-486 DOI: 10.1177/1558944717744338.
    CrossrefPubMedGoogle Scholar
  • 24 Carlson MG, Warner KK, Meyers KN, Hearns KA, Kok PL. Mechanics of an anatomical reconstruction for the thumb metacarpophalangeal collateral ligaments. J Hand Surg Am 2013; 38 (01) 117-123 DOI: 10.1016/j.jhsa.2012.09.015.
    CrossrefPubMedGoogle Scholar
  • 25 Tiznado G, Sousa-Rodrigues C, Olave E. Ramo superficial del nervio radial: Amplia distribución en el dorso de la mano. Int J Morphol 2012; 30 (02) 374-378
    CrossrefPubMedGoogle Scholar
  • 26 Ropars M, Fontaine I, Morandi X, Berton E, Kaila R, Darnault P. Preserving the superficial branch of the radial nerve during carpometacarpal and metacarpophalangeal joint arthroscopy: an anatomical study. Surg Radiol Anat 2010; 32 (03) 271-276 DOI: 10.1007/s00276-010-0622-8.
    CrossrefPubMedGoogle Scholar
  • 27 Pulos N, Shin AY. Treatment of Ulnar Collateral Ligament Injuries of the Thumb: A Critical Analysis Review. JBJS Rev 2017; 5 (02) 01874474-201702000-00005 DOI: 10.2106/JBJS.RVW.16.00051.
    CrossrefPubMedGoogle Scholar