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Biomechanical in vitro comparison of suture anchors for thumb UCL repair

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Abstract

Different types of intraosseous suture anchors can be used for thumb ulnar collateral ligament (UCL) repair surgery. Some of them have already been tested biomechanically in intact bone; however, there exists little knowledge of their stability when implanted in avulsion fracture. In this biomechanical in vitro study, three anchor types (hard, soft and novel BoneWelding) were tested on 24 fresh frozen human thumbs from 12 body donors. After the repair of an iatrogenic ligamentous UCL rupture, the thumbs were cyclically loaded. A new set of anchors was implanted at the contralateral radial side of the same specimen into an iatrogenic avulsion fracture and pulled out of the bone. The most common mode of failure in ligamentous UCL repairs was the suture–ligament interface, especially when using soft anchors. In avulsion fractures, the novel anchor withstood significantly higher pullout forces than the hard or soft anchor (65 N vs. 42 N vs. 27 N; p = .006). The BW anchor provides sufficient anchorage in trabecular bone for UCL repair in case of avulsion fractures.

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References

  1. Avery DM, Caggiano NM, Matullo KS (2015) Ulnar collateral ligament injuries of the thumb: a comprehensive review. Orthop Clin North Am 46(2):281–292

    Article  PubMed  Google Scholar 

  2. Chuter GSJ, Muwanga CL, Irwin LR (2009) Ulnar collateral ligament injuries of the thumb: 10 years of surgical experience. Injury 40(6):652–656

    Article  CAS  PubMed  Google Scholar 

  3. Cooper JG, Johnstone AJ, Hider P et al (2005) Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries. Emerg Med Australas 17(2):132–136

    Article  PubMed  Google Scholar 

  4. Coyle MP (2003) Grade III radial collateral ligament injuries of the thumb metacarpophalangeal joint: treatment by soft tissue advancement and bony reattachment. J Hand Surg Am 28(1):14–20

    Article  PubMed  Google Scholar 

  5. Crowley TP, Stevenson S, Taghizadeh R et al (2013) Early active mobilization following UCL repair with Mitek bone anchor. Tech Hand Up Extrem Surg 17(3):124–127

    PubMed  Google Scholar 

  6. Firoozbakhsh K, Yi IS, Moneim MS et al (2002) A study of ulnar collateral ligament of the thumb metacarpophalangeal joint. Clin Orthop Relat Res 403:240–247

    Article  Google Scholar 

  7. Gluck JS, Balutis EC, Glickel SZ (2015) Thumb ligament injuries. J Hand Surg Am 40(4):835–842

    Article  PubMed  Google Scholar 

  8. Harley BJ, Werner FW, Green JK (2004) A biomechanical modeling of injury, repair, and rehabilitation of ulnar collateral ligament injuries of the thumb. J Hand Surg Am 29(5):915–920

    Article  PubMed  Google Scholar 

  9. Hintermann B, Holzach PJ, Schutz M et al (1993) Skier’s thumb—the significance of bony injuries. Am J Sports Med 21(6):800–804

    Article  CAS  PubMed  Google Scholar 

  10. Jarrett CD, McGillivary GR, Hutton WC (2010) The 2.5 mm PushLock suture anchor system versus a traditional suture anchor for ulnar collateral ligament injuries of the thumb: a biomechanical study. J Hand Surg Eur 35(2):139–143

    Article  CAS  Google Scholar 

  11. Katolik LI, Friedrich J, Trumble TE (2008) Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques. Plast Reconstr Surg 122(5):1451–1456

    Article  CAS  PubMed  Google Scholar 

  12. Kottstorfer J, Hofbauer M, Krusche-Mandl I et al (2013) Avulsion fracture and complete rupture of the thumb radial collateral ligament. Arch Orthop Trauma Surg 133(4):583–588

    Article  CAS  PubMed  Google Scholar 

  13. Lange T, Schmoelz W, Gosheger G et al (2017) Is a gradual reduction of stiffness on top of posterior instrumentation possible with a suitable proximal implant? A biomechanical study. Spine J 17(8):1148–1155

    PubMed  Google Scholar 

  14. Langer MF, Hermann K, Oeckenpöhler S et al (2015) Ulnare Kollateralbandplastik des Daumengrundgelenks bei chronischer Instabilität. Oper Orthop Traumatol 27(5):380–393

    Article  CAS  PubMed  Google Scholar 

  15. Madan SS, Pai DR, Kaur A et al (2014) Injury to ulnar collateral ligament of thumb. Orthop Surg 6(1):1–7

    Article  PubMed  Google Scholar 

  16. Malik AK, Morris T, Chou D et al (2009) Clinical testing of ulnar collateral ligament injuries of the thumb. J Hand Surg Eur Vol 34(3):363–366

    Article  CAS  PubMed  Google Scholar 

  17. Michaud EJ, Flinn S, Seitz WH, JR (2010) Treatment of grade III thumb metacarpophalangeal ulnar collateral ligament injuries with early controlled motion using a hinged splint. J Hand Ther 23(1):77–82

    Article  PubMed  Google Scholar 

  18. Moharram AN, Ashraf N (2013) Repair of thumb metacarpophalangeal joint ulnar collateral ligament injuries with microanchors. Ann Plast Surg 71(5):500–502

    Article  CAS  PubMed  Google Scholar 

  19. Obremskey WT, Pappas N, Attallah-Wasif E et al (2005) Level of evidence in orthopaedic journals. J Bone Joint Surg Am 87(12):2632–2638

    Article  PubMed  Google Scholar 

  20. Patel S, Potty A, Taylor EJ et al (2010) Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm. Strategies Trauma Limb Reconstr 5(1):1–10

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rhee PC, Jones DB, Kakar S (2012) Management of thumb metacarpophalangeal ulnar collateral ligament injuries. J Bone Joint Surg Am 94(21):2005–2012

    Article  PubMed  Google Scholar 

  22. Riederer B, Brenner E, Bueno-Lopez J et al (2008) The legal and ethical framework governing Body Donation in Europe—1st update on current practice. Eur J Anat 16:1–21

    Google Scholar 

  23. Rocchi L, Merolli A, Morini A et al (2014) A modified spica-splint in postoperative early-motion management of skier’s thumb lesion: a randomized clinical trial. Eur J Phys Rehabil Med 50(1):49–57

    CAS  PubMed  Google Scholar 

  24. Samora JB, Harris JD, Griesser MJ et al (2013) Outcomes after injury to the thumb ulnar collateral ligament—a systematic review. Clin J Sport Med 23(4):247–254

    Article  PubMed  Google Scholar 

  25. Thomopoulos S, Zampiakis E, Das R et al (2008) The effect of muscle loading on flexor tendon-to-bone healing in a canine model. J Orthop Res 26(12):1611–1617

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ziegler C, Neshkova I, Schmidt K et al (2016) Operative Behandlung der ulnaren Seitenbandläsion am Daumengrundgelenk. Oper Orthop Traumatol 28(2):111–126 (quiz 127)

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank all individuals who donated their bodies and tissues for the advancement of education and research.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    M. Wagner, W. Schmoelz & R. Arora

  2. Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria

    H. Stofferin

Authors
  1. M. Wagner
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  2. W. Schmoelz
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  3. H. Stofferin
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  4. R. Arora
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Corresponding author

Correspondence to R. Arora.

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Conflict of interest

The company SportWelding (Schlieren, CH) supported the laboratory cost of this study. The study, however, was performed independently at the biomechanical laboratory of the Department for Trauma Surgery at the Medical University of Innsbruck. The authors declare that they have no conflict of interest.

Informed consent

Twenty-four human thumbs from twelve body donors were used in this study. The bodies were donated by people who had given their written informed consent for their use for scientific and educational purposes prior to death.

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Wagner, M., Schmoelz, W., Stofferin, H. et al. Biomechanical in vitro comparison of suture anchors for thumb UCL repair. Arch Orthop Trauma Surg 138, 435–442 (2018). https://doi.org/10.1007/s00402-018-2877-1

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  • DOI: https://doi.org/10.1007/s00402-018-2877-1

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