reconstruction

Definition

Injury to ulnar collateral ligament of thumb MCPJ

Interferes with pinch grip and grasp and thumb is ineffective as a post

Issues

Operative v Nonoperative

Levy et al Arthroscopy 2009

- systematic Review

- improved outcomes with operative management

https://pubmed.ncbi.nlm.nih.gov/19341932/

Vicenti et al. Injury 2019

- systematic review

- two studies compare operative v nonoperative

Epidemiology

Middle age men

Steroids / Growth Hormone

Aetiology

Usually occurs in gym

Bench Press

Clinical

Significant bruising in the acute phase

In chronic setting, ask patient to adduct against hip / resistance

Epidemiology

Usually occurs in patients over 60

- due to decreased vascularity & collagen weakness

Younger patient on steroids / growth hormone

Occasionally occurs in young athlete with excessive contracture

Aetiology

Often preceded by quadriceps tendinosis

Indication

1.  Acute < 3/52

- single bundle

2.  Chronic

- double bundle

Technique Single Bundle

Set up

- knee at 90 degrees on bolster

- x-ray getting lateral of knee

Epidemiology

Usually occurs in young people

- often previous history of tendonitis ± steroid injections

Location

Usually at level of inferior pole of patella

- less common at tibial tubercle

- mid-substance ruptures rare

Clinical

Severe pain

Palpable defect

Extensor deficit / unable to SLR

Xray

Patella alta / high riding patella

Issues

Limb alignment

Risk that late posterolateral corner reconstruction will fail in the setting of the varus knee

- varus knee alignment and varus thrust in stance phase

- consider osteotomy first in this setting

Results

Posterolateral Corner Reconstruction

Moulton et al. Am J Sports Med 2016

- systematic review of PCL reconstruction for chronic injuries

- 450 patients