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Radial collateral ligament repair of the thumb: long-term outcomes and predictive factors of postoperative deficits.
Arch Orthop Trauma Surg. 2020 Jun 04 [Online ahead of print]AO

Abstract

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

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

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

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.

Authors+Show Affiliations

Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany. Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany. Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany. Department of Plastic, Reconstructive and Aesthetic Surgery, ISAR Klinikum, Munich, Germany.Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany. sebastian.fischer@bgu-ludwigshafen.de.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32500203

Citation

Haug, Valentin F M., et al. "Radial Collateral Ligament Repair of the Thumb: Long-term Outcomes and Predictive Factors of Postoperative Deficits." Archives of Orthopaedic and Trauma Surgery, 2020.
Haug VFM, Diehm YF, Pfeiler P, et al. Radial collateral ligament repair of the thumb: long-term outcomes and predictive factors of postoperative deficits. Arch Orthop Trauma Surg. 2020.
Haug, V. F. M., Diehm, Y. F., Pfeiler, P., Kotsougiani-Fischer, D., Bickert, B., Kneser, U., Hirche, C., & Fischer, S. (2020). Radial collateral ligament repair of the thumb: long-term outcomes and predictive factors of postoperative deficits. Archives of Orthopaedic and Trauma Surgery. https://doi.org/10.1007/s00402-020-03509-0
Haug VFM, et al. Radial Collateral Ligament Repair of the Thumb: Long-term Outcomes and Predictive Factors of Postoperative Deficits. Arch Orthop Trauma Surg. 2020 Jun 4; PubMed PMID: 32500203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radial collateral ligament repair of the thumb: long-term outcomes and predictive factors of postoperative deficits. AU - Haug,Valentin F M, AU - Diehm,Yannick F, AU - Pfeiler,Peter, AU - Kotsougiani-Fischer,Dimitra, AU - Bickert,Berthold, AU - Kneser,Ulrich, AU - Hirche,Christoph, AU - Fischer,Sebastian, Y1 - 2020/06/04/ PY - 2020/03/24/received PY - 2020/05/31/accepted PY - 2020/6/6/entrez KW - Metacarpophalangeal joint-1 KW - Radial collateral ligament KW - Stener lesion KW - Thumb JF - Archives of orthopaedic and trauma surgery JO - Arch Orthop Trauma Surg N2 - 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: 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: 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: 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. SN - 1434-3916 UR - https://www.unboundmedicine.com/medline/citation/32500203/Radial_collateral_ligament_repair_of_the_thumb:_long-term_outcomes_and_predictive_factors_of_postoperative_deficits L2 - https://dx.doi.org/10.1007/s00402-020-03509-0 DB - PRIME DP - Unbound Medicine ER -
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