Purpose
This study evaluated knee collateral ligaments for use as allografts in small joint
reconstruction in the hand, specifically the thumb metacarpophalangeal (MCP) joint
ulnar collateral ligament (UCL) and the index finger proximal interphalangeal (PIP)
joint radial collateral ligament (RCL), and compared them to the current gold standard,
tendon autograft.
Methods
Uniaxial tensile testing was performed on native thumb MCP UCLs and index finger PIP
RCLs and 2.5-mm–diameter grafts prepared from hemi-flexor carpi radialis (hemi-FCR)
tendons and knee medial collateral ligaments (MCLs) cadaveric allografts. In situ angular testing was performed in thumb MCP and index finger PIP joints. Each MCP/PIP
joint was secured to a mechanical testing system and cyclically loaded. The UCL/RCL
was resected and reconstructed with either an MCL or hemi-FCR. Cyclic loading was
repeated, followed by angular load to failure.
Results
Uniaxial testing of MCL allografts demonstrated greater ultimate stress, ultimate
load, and elastic modulus than hemi-FCR grafts and native UCLs/RCLs. The maximum angular
deviation of the reconstructed MCP and PIP joints was not significantly different
compared with the intact joint with either an MCL or hemi-FCR graft. In situ load to failure demonstrated no differences in failure torque or angular stiffness
between MCPs reconstructed with a hemi-FCR and MCL allograft, whereas reconstructed
PIP joints demonstrated improved angular stiffness with an MCL allograft compared
with a hemi-FCR.
Conclusions
Medial collateral ligament allografts demonstrated improved mechanical properties
compared with hemi-FCR tendon grafts during uniaxial testing, and grafts performed
equivalently in in situ testing of reconstructed thumb/finger joints.
Clinical relevance
Prepared knee ligament allografts may provide a viable graft material for use in reconstruction
of small hand ligaments. This new allograft material avoids the need to harvest a
tendon autograft and has a biologic structure similar to native hand ligaments.
Key words
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References
- Mechanics of an anatomical reconstruction for the thumb metacarpophalangeal collateral ligaments.J Hand Surg Am. 2013; 38: 117-123
- Reconstruction of the ulnar collateral ligament of the thumb metacarpophalangeal joint: a cadaver study.J Hand Surg Am. 2005; 30: 394-399
- A new technique for reconstruction of the ulnar collateral ligament of the thumb.Am J Sports Med. 2007; 35: 1321-1325
- Management of proximal interphalangeal joint fractures and dislocations.J Hand Ther. 2003; 16: 117-128
- Thumb metacarpophalangeal joint ulnar collateral ligament reconstruction using a tendon graft.Tech Hand Up Extrem Surg. 2002; 6: 133-139
- Collateral ligament injuries of the thumb metacarpophalangeal joint.J Am Acad Orthop Surg. 2011; 19: 287-296
- Green’s Operative Hand Surgery.7th ed. Elsevier, 2016
- Mechanical properties of the human Achilles tendon.Clin Biomech (Bristol, Avon). 2001; 16: 245-251
- Autologous tendon grafts used in upper limb surgery.Open J Orthop. 2013; 03: 74-78
- Adequacy of palmaris longus and plantaris tendons for tendon grafting.J Hand Surg Am. 2011; 36: 695-698
- Repair of the thumb ulnar collateral ligament with suture tape augmentation.Tech Hand Up Extrem Surg. 2017; 21: 164-166
- Scapholunate ligament internal brace 360-degree tenodesis (SLITT) procedure.J Wrist Surg. 2018; 7: 336-340
- Suture tape augmentation of the thumb ulnar collateral ligament repair: a biomechanical study.J Hand Surg Am. 2018; 43: 868.e1-868.e6
- Biomechanical comparison of docking ulnar collateral ligament reconstruction with and without an internal brace.J Shoulder Elbow Surg. 2019; 28: 2247-2252
- Uç değişik emilmeyen dikiş malzemesine karşi oluşan doku yanitinin tavşan modelinde incelenmesi. Evaluation of soft tissue reactions to three nonabsorbable suture materials in a rabbit model.Acta Orthop Traumatol Turc. 2009; 43: 366-372
- Wound complications following the use of FiberWire in lower-extremity traumatic amputations. A case series.J Bone Joint Surg Am. 2009; 91: 680-685
- Sterile abscess with subsequent iatrogenic draining sinus tract formation 3 years after FiberWire and ENDOBUTTON distal biceps brachii tendon repair: a case report.JBJS Case Connect. 2017; 7: e32
- Foreign body granulomatous reaction associated with polyethelene ‘Fiberwire®’ suture material used in Achilles tendon repair.Foot Ankle Surg. 2014; 20: e27-e29
- Tissue-engineered collateral ligament composite allografts for scapholunate ligament reconstruction: an experimental study.J Hand Surg Am. 2012; 37: 1529-1537
- Anatomy of the thumb metacarpophalangeal ulnar and radial collateral ligaments.J Hand Surg Am. 2012; 37: 2021-2026
- Green’s Operative Hand Surgery.Elsevier/Churchill Livingstone, 2011: 304
- Statistical Power Analysis for the Behavioral Sciences.2nd ed. Routledge, 1988
- Orthopaedic biomechanics: mechanics and design in musculoskeletal systems.Chapter 4: Tissue Mechanics II: Soft Tissue. Pearson/Prentice Hall, 2009: 121-164
- Complications of proximal interphalangeal joint injuries: prevention and treatment.Hand Clin. 2018; 34: 267-288
- Evaluation of “neocollateral” ligament formation by magnetic resonance imaging after total excision of the proximal interphalangeal collateral ligaments.J Hand Surg Am. 1998; 23: 322-327
- Radial collateral ligament injury of the index metacarpophalangeal joint: an underreported but important injury.J Hand Surg Am. 2006; 31: 1355-1361
- Thumb metacarpophalangeal ulnar collateral ligament injuries: a biomechanical simulation study of four static reconstructions.J Hand Surg Am. 2005; 30: 1056-1060
- Do Processing methods make a difference in acellular dermal matrix properties?.Aesthet Surg J. 2016; 36: S7-S22
- The role of endotoxin in sterile inflammation after implanted acellular dermal matrix: red breast syndrome explained?.Aesthet Surg J. 2020; 40: 392-399
- Chemical sterilization of allograft dermal tissues.Cell Tissue Bank. 2017; 18: 573-584
- Allograft compared with autograft infection rates in primary anterior cruciate ligament reconstruction.J Bone Joint Surg Am. 2010; 92: 2402-2408
Article info
Publication history
Published online: October 26, 2022
Accepted:
August 10,
2022
Received:
July 21,
2021
Publication stage
In Press Corrected ProofFootnotes
Drs Block, Kulber, Sun, An, and Metzger and author Nelson report support from MTF Biologics. Dr Kulber is on the Medical Board of MTF Biologics. No benefits in any form have been received or will be received by Dr Yoshida related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
