The Role of Arthroscopy of Acute and Chronic Painful Thumb Metacarpophalangeal Joint

PURPOSE: There has been few published on arthroscopy of metacarpophalangeal joint (MCPJ) despite increasingly being used worldwide. The purpose of this study was to investigate the effectiveness of arthroscopy for pathologies around MCPJ of the thumb. METHODS: Between September 2007 and June 2015, 56 patients (56 thumb) who underwent arthroscopy of the MCPJ were retrospectively studied. Preoperative diagnoses, which were made through physical examination, plain radiograph, stress radiography, ultrasound, and magnetic resonance images (MRI), were compared with arthroscopic findings. Therapeutic arthroscopic surgeries were performed according to the needs of each patient. Functional outcomes were assessed with physical examination as well as disabilities of the arm, shoulder and hand (DASH) score and Michigan Hand outcomes Questionnaire (MHQ) score at an average 7.3 months follow-up. RESULTS: Six patients who suspected with collateral ligament injuries in MRI confirmed different diagnoses under arthroscopy. At final follow-up, the mean range of flexion contracture of the MCPJ was 5°, and the mean range of further flexion was 52.7°. Grip and pinch strength averaged 87.2% and 79.3% of contralateral side. Mean DASH and MHQ score were improved from 48.1 and 44.6, preoperatively to 14.9 and 26.3, postoperatively (p<0.001, p=0.012, respectively). All patients were satisfied with their outcomes at final follow-up, except 4 patients who noted joint stiffness or chronic pain around the thumb. CONCLUSION: Our results revealed that arthroscopy is helpful for both diagnostic and therapeutic purposes of acute and chronic painful MCPJ of the thumb. However, further studies are needed to expand the applications of arthroscopy of MCPJ of the thumb.

Observations on the Therapeutic Effect of Gentle Moxibustion on Old Interphalangeal Collateral Ligament Injury / 上海针灸杂志

ObjectiveTo investigate the clinical efficacy of gentle moxibustion in treating old interphalangeal collateral ligament injury.MethodSixty patients were randomly allocated to two groups. The treatment group of 30 patients received gentle moxibustion 20-30 min once daily for two consecutive courses of treatment. The control group of 30 patients received TDP irradiation 20-30 min once daily for two consecutive courses of treatment.ResultThe excellent rate and the total excellent rate were 56.7% and 83.3%, respectively, in the treatment group and 36.7% and 76.7%, respectively, in the control group; there were statistically significant differences between the two groups (P<0.01).ConclusionGentle moxibustion has a marked therapeutic effect on old interphalangeal collateral ligament injury.

Surgical Management of Comminuted Avulsion Fracture of the Proximal Fibula with Lateral Collateral Ligament Injury: Technical Note

Anteromedial force to the knee in an extended position can cause an avulsion fracture of the proximal fibula with combined injuries to the posterolateral ligaments. Avulsion fractures of the proximal fibula are rare and current management of these fractures is based on few descriptions in literature. Various surgical methods of fixation for these fractures have been reported, but there is still no standard treatment modality. Anatomic reduction of these fractures is technically difficult, and failure of reduction may cause posterolateral instability, secondary arthritis and other complications. We present our experience with two such cases of comminuted avulsion fractures of the proximal fibular with posterolateral ligament ruptures surgically fixated with a locking compression hook plate and non absorbable sutures.

Medial Collateral Ligament Reconstruction with Semitendinosus Autograft for Medial Instability of the Knee:Report of 12 Cases / 中国微创外科杂志

Objective To investigate the effect of medial collateral ligament reconstruction using semitendinosus autograft.Methods A total of 12 patients with medial collateral ligament injury received knee examinations.Among them,2 had lateral meniscus injury,and received partial resection of the lateral meniscus;2 had cruciate ligament(CL) injury(anterior CL in one and posterior CL in the other),and underwent bone-ligament-bone reconstruction.Medial collateral ligament reconstruction was performed using the semitendinosus tendon autograft ingrowth in the tibial tunnel.Results Primary healing was achieved in all the cases.In 10 of them,the stability of the knee was regained in 6-month follow-up;stress X-ray examination showed that the medial joint space was smaller than the contralateral one by less than 5 mm,and the position of the interference screw was optimal.Of the 12 patients,11 achieved an active knee flexion between 0? and 120?,the other,who had fracture of the lateral condyle of the femur,had a flexion of 90?.Conclusions Semitendinosus autograft provides sufficient tension for medial collateral ligament reconstruction.The fixation of the knee and the closure of the joint capsule can be achieved by using the method.

Comparative Analysis of Medial Collateral Ligament Grade III injury of the Knee / 대한정형외과학회잡지

The medial collateral ligament is the most commonly injured ligamentous structure of the knee and it has been demonstrated that this ligament is the prime static stabilizer of the medial side of the knee joint. The management of the medial collateral ligament injuries were divided into surgical and conservative treatment. Many investigators reported consistently good to excellent results following surgical treatment. More recently, other investigators reported that isolated medial collateral ligament injuries did equally well under non-operative as operative treatment. For accurate diagnosis, arthroscopic examination of the knee to rule out other intraarticular pathologic conditions such as cruciate ligament injuries, maniscal tears and bony injuries is essential. From October 1988 to January 1991, we treated 76 cases of isolated medial collateral ligament injuries which was confirmed by diagnostic arthroscopy. Among them, we analyzed 31 cases that minimum follow-up was over 1 year and could be re-examed, 20 cases were treated with surgery and 11 cases were not. With comparision between initial and final follow-up stress X-ray, 5.45 ± 3.17mm in non-operative group had improved in medial laxity(P 0.05). In conclusion, medial stability was improved in operative than in non-operative group, however functional score was equally well under non-operative as operative treatment.

Collateral Ligament Injury of the Fingers / 대한정형외과학회잡지

Collateral ligament injury of the IP joint of the fingers are common and almost always occurs at the PIP joint. But the rupture of collateral ligament is often miss-diagnosed as sprain and it's seriousness is often underestimated, of such injuries frequently result in prolonged and even permanent disability of the injured fingers. During the period of Sept. 1986 to Aug. 1988, 16 collateral ligament injuries in 15 patients were treated surgically at Holy Family Hospital, Bu Cheon and following results were obtained: 1. Among 15 patients, 14 were male and the age was 32.1 years on an average. 2. The 7 cases had associated injuries in the same fingers. 3. In 6 cases ligaments were ruptured at the proximal attachment, in 5 at the distal attachment, and in 5 at the ligament substance. 4. Average range of joint motion at the final observation was 69.2°. The average flexion contracture was 9.3°, and the average further flexion was 78.5°. 5. The flexion was limited more than the average when the ligament was ruptured at the insertion(66°) and when there were other associated injuries in the same finger(58.1°). The extension was limited more than the average when the ligament was ruptured at the substance(18°) and when patients were over the age of 31 years(12.5°).

A Clinical Analysis of Collateral Ligament Injuries to Fingers / 대한정형외과학회잡지

There are many controversies concerning diagnostic and therapeutic guidlines for injuries to the collateral ligaments of the fingers, which improperly treated, may develop serious late sequale of joint function. Eleven cases of collateral ligament injuries to fingers which occured between June 1976 and June 1986 were reviewed and the following results were obtained. 1. There were 8 males and 3 females, and eight of the 11 cases (73%) were younger than 30 years of age. 2. In 5 cases, the injury was a sports related injury, while slipped down injury caused the injury in 5 other cases. 3. The ratio of acute to chronic injury was 7:4. 4. There were 6 cases of proximal interphalangeal joint of the fifth finger, 3 cases of metacarpophalangeal joint of the first finger and 2 cases of proximal interphalangeal joint of the third finger. 5. The ratio of ulnar collateral ligament to radial collateral ligament was 7:4. 6. Preoperatively, stress X-rays of the both the involved and the contralateral sound joints taken in all cases and analysed. 7. The most common ruptured site of ligament was substance portion, which was found in 7 cases. 8. Primary repair were performed in 8 cases, reconstruction with tendon of palmaris longus muscle in 2 cases and reconstruction with tendon of flexor digitorum superficialis in 1 case. 9. All patients were followed for at least 6 months, and the average was 3 years. 10. Normal range of motion and stable joints were observed in 10 of the 11 cases at the final follow up.