Collateral ligament prosthesis for the repair of subluxation of the metatarsophalangeal joint in a Jersey cow

2000 ◽  
Vol 146 (22) ◽  
pp. 640-643 ◽  
Author(s):  
J. Rothlisberger ◽  
P. Kircher ◽  
A. Steiner
Keyword(s):  
Metatarsophalangeal Joint ◽  
Collateral Ligament ◽  
Ligament Prosthesis

scholarly journals SAT0561 METATARSOPHALANGEAL JOINT MEDIAL COLLATERAL LIGAMENT MEASUREMENT, A NOVEL ULTRASOUND FEATURE OF MONOSODIUM URATE DEPOSITION IN THE JOINT.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1238.1-1239
Author(s):  
R. Flood ◽  
D. Kane ◽  
R. Mullan
Keyword(s):  
Medial Collateral Ligament ◽  
Metatarsophalangeal Joint ◽  
Musculoskeletal Ultrasound ◽  
Surrounding Tissue ◽  
Foot Pain ◽  
Monosodium Urate ◽  
Collateral Ligament ◽  
Crystal Deposition ◽  
First Metatarsophalangeal Joint ◽  
Double Contour

Background:Acute gouty arthritis most commonly initially affects the first metatarsophalangeal joint (MT1). (1) Musculoskeletal ultrasound (US) is a reliable tool for detecting monosodium urate crystal (MSU) deposition in gout and hyperuricemia with validated, ultrasound features of double contour (DC) sign, tophus, and erosions. (2, 3) The collateral ligaments of MT1, which originate on the medial and lateral epicondyles of the metatarsals and extend to the proximal phalanx, function to stabilize the joint. (4) While tophus deposition typically occurs between the medial collateral ligament (MCL) and head of MT1, small MSU aggregates may be indistinguishable from surrounding tissue. In this study using US, we propose that an increased vertical depth between the superficial surface of the MCL to cortical surface of MT1 (dMC-MT) is indicative of MSU deposition (see figure 1). The aim was to evaluate associations of dMC-MT with serum uric-acid level (sUA) in a cohort of individuals with hyperuricaemia and non-episodic foot pain. We propose a novel sonographic feature of MSU crystal deposition in the MT joint.Objectives:1.)To evaluate the association between sUA and dMC-MT2.)To record the presence/absence of classical features of MSU deposition including; double contour sign, erosions and tophi in a cohort of patients with hyperuricaemia and foot pain.3.)To evaluate the associations between sUA and dMC-MT in those with\without classical features of MSU deposition (DC, erosion, tophi).Methods:Following informed consent, hyperuricaemic patients (n = 52) underwent bilateral US of the 1MT using LogiqE9 at 15 MHz. Features of MSU deposition including DC sign, tophus and juxta-articular erosion were recorded. The dMC-MT was measured as the mean of the perpendicular distance between the superficial surface of the midpoint of the MCL to the MT1 head. Statistical analysis was performed using SPSS V.25 software. Data presented as MEAN ± S.E unless otherwise indicated.Results:DC sign, tophus and erosion occurred in 31%, 20.7% and 19% of cases, respectively. Mean sUA was higher in tophus positive (540 ± 36) versus non tophus (470 ± 16) (p<0.01) and erosion positive (522 ± 32) versus non erosion (477± 17) patients. dMC-MT was significantly greater in tophus positive patients (0.34cm ± 0.17cm) versus non tophus (0.27cm ± 0.01cm) (p < 0.01). dMC-MT was significantly greater in erosion positive patients (0.31cm ± 0.18cm) versus non erosion (0.28cm +0.01cm) (p < 0.05). In DC negative patients dMC-MT was significantly correlated with increasing sUA (r = 0.34 p = <0.05). No correction between dMC-MT and sUA was seen in DC positive patients.Conclusion:dMC-MT is significantly greater both in patients with tophus and erosions indicating its role as an additional marker of MSU crystal deposition. Furthermore a significant association between dMC-MT and sUA in DC negative patients suggests that dMC-MT may be a more sensitive indicator of early urate deposition in a subset of patients where the earliest site of urate deposition has not occurred directly on to articular hyaline cartilage. dMC-MT may therefore be a sensitive tool for very early urate deposition. Further studies clarifying a role for dMC-MT are now required.References:[1]Wallace SL, Robinson H, Masi AT, Decker JL, Mccarty DJ, Yü T -f. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977;20(3):895–900.[2]Howard RG, Pillinger MH, Gyftopoulos S, Thiele RG, Swearingen CJ, Samuels J. Reproducibility of musculoskeletal ultrasound for determining monosodium urate deposition: Concordance between readers. Arthritis Care Res. 2011;63(10):1456–62.[3]Stewart S, Dalbeth N, Vandal AC, Rome K. Characteristics of the first metatarsophalangeal joint in gout and asymptomatic hyperuricaemia: A cross-sectional observational study. J Foot Ankle Res. 2015;8(1):1–8.[4]Finney FT, Cata E, Holmes JR, Talusan PG. Anatomy and Physiology of the Lesser Metatarsophalangeal Joints. Foot Ankle Clin. 2018;23(1):1–7.Disclosure of Interests:None declared

Lateral Collateral Ligament Repair for Hallux Metatarsophalangeal Joint Instability in a Collegiate Sumo Wrestler: A Case Report

2021 ◽  
Vol 111 (1) ◽  
Author(s):  
Sadanori Shimizu ◽  
Tetsuya Sato ◽  
Tomohiko Tateishi ◽  
Tsuyoshi Nagase ◽  
Teruhiko Nakagawa ◽  
...  
Keyword(s):  
Athletic Performance ◽  
Joint Instability ◽  
Lateral Collateral Ligament ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Bone ◽  
Burr Hole ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Surgical Treatments

Although sprains of the hallux metatarsophalangeal (MTP) joint ligaments occur in barefooted martial arts athletes, few studies discuss the surgical treatments for lateral collateral ligament damage. We report herein a case of lateral collateral ligament repair for chronic hallux MTP joint instability. A 21-year-old male collegiate sumo wrestler injured his left hallux by snagging it on a sumo straw bale at 14 years of age. After entering university (4 years after the injury), he could no longer put weight on his foot at the left hallux; his athletic performance deteriorated, and he was referred to our department by his doctor. He had instability in the MTP joint of the left hallux, and magnetic resonance imaging revealed a tear in the attachment of the lateral collateral ligament to the metatarsal bone. Conservative treatment, such as taping, did not improve the symptoms; thus, surgery was performed, which consisted of passing a strong suture attached to the capsular ligament through a burr hole made in the metatarsal bone and fixing it to the burr-hole wall using an anchor. Postoperatively, the patient's joint instability improved, and he returned to competitive wrestling 4 months after surgery. He was able to put weight on his left hallux, and his athletic performance improved. The follow-up period after surgery was 2 years. In competitive sumo wrestling, hallux weakness and joint instability lead to a significant reduction in performance. Thus, ligament repair is an effective treatment for hallux MTP joint instability that cannot be treated by conservative means.

Collateral Ligament Reconstruction of the Unstable Metatarsophalangeal Joint: An in Vitro Study

Foot & Ankle ◽  
1992 ◽  
Vol 13 (7) ◽  
pp. 391-395 ◽  
Author(s):  
Jonathan T. Deland ◽  
Mark Sobel ◽  
Steven P. Arnoczky ◽  
Francesca M. Thompson
Keyword(s):  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
In Vitro Study ◽  
Metatarsal Head ◽  
Anatomic Reconstruction ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Toe Deformity ◽  
Metatarsophalangeal Joints

Anatomic reconstruction of the collateral ligaments of the lesser metatarsophalangeal joints is proposed for certain cases of metatarsophalangeal instability. The suggested reconstruction involves replication of the attachments of the collateral ligaments. As an example of such a reconstruction, the interosseous tendon was used in this study as a graft for anatomic replacement of the collateral ligaments. The tendon was left attached distally where its attachments include the volar plate and proximal phalanx, thereby resembling the distal attachment of the collateral ligament. The proximal portion of the tendon was inserted into the metatarsal head, replicating the attachment of the collateral ligament at that location. Preliminary testing of such a reconstruction shows that it can re-establish stability caused by loss of the collateral ligaments. Such a procedure may be applicable in select cases of crossover toe deformity and straight vertical instability.

scholarly journals Novel dynamic stabilization method for medial instability of the first metatarsophalangeal joint

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987768 ◽  
Author(s):  
Zoltán Koós ◽  
Krisztián Sisák
Keyword(s):  
Return To Sport ◽  
Metatarsophalangeal Joint ◽  
Tendon Graft ◽  
Ligament Injury ◽  
Stabilization Method ◽  
Collateral Ligament ◽  
Correct Position ◽  
Chronic Instability ◽  
First Metatarsophalangeal Joint ◽  
Medial Collateral Ligament Injury

Medial collateral ligament injury of the first metatarsophalangeal (MTP) joint is rare. If it is missed, chronic instability and traumatic hallux valgus develop, requiring surgical treatment. Different methods have been reported in the limited available literature aiming to restore the balance between the lateral and medial stabilizers by tightening the medial joint capsule with or without additional tendon graft. Our described method utilizes a suture button device (Mini TightRope, Arthrex, Naples, Florida) for reconstruction. This device applies tension to hold the hallux in the correct position, providing stability. Relevant diagnostic regimen, surgical technique, and postoperative care are described, along with a case of a handball player who underwent this procedure. He continues to perform at the same level 38 months postoperatively. Mini TightRope fixation for chronic medial first MTP instability has not been reported. It does not require postoperative immobilization and allows faster return to sport, so it seems superior to other methods when treating athletes.

scholarly journals Reconstruction of the Lateral Collateral Ligament Using a Suture Tape Anchor for Iatrogenic Hallux Varus

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Akinori Nekomoto ◽  
Tomoyuki Nakasa ◽  
Yasunari Ikuta ◽  
Junichi Sumii ◽  
Nobuo Adachi
Keyword(s):  
Hallux Valgus ◽  
Tendon Transfer ◽  
Donor Site ◽  
Lateral Collateral Ligament ◽  
Metatarsophalangeal Joint ◽  
Varus Deformity ◽  
Anatomical Reconstruction ◽  
Collateral Ligament ◽  
Hallux Varus ◽  
Suture Tape

Iatrogenic hallux varus is a difficult complication of hallux valgus surgery. Although tendon transfer combined with bony correction is performed for hallux varus, tendon transfer has several disadvantages, such as the complicated nature of the procedure and the donor site morbidity. We describe the case of a 70-year-old woman with iatrogenic hallux varus treated by lateral collateral ligament (LCL) reconstruction using a suture tape anchor with bony correction. Tarsometatarsal joint arthrodesis was performed to correct the narrow intermetatarsal angle (IMA), and the varus deformity of the great toe at the metatarsophalangeal joint was corrected by anatomical reconstruction of the LCL using the suture tape anchor. One year postoperatively, the Japanese Society for Surgery of the Foot Hallux Metatarsophalangeal-Interphalangeal Scale had improved from 37 to 90 points. Radiography confirmed that the hallux valgus angle had been corrected from -24° to 4° and the IMA from 0° to 8°. Reconstruction of the LCL using suture tape anchor is an easy procedure for iatrogenic hallux varus which can achieve good stabilization.

Collateral Ligament Prosthesis for Stabilization of Transverse Subchondral Fracture of Metatarsus III/IV in a Calf

1997 ◽  
Vol 10 (01) ◽  
pp. 33-36
Author(s):  
P. Schawalder ◽  
A. Steiner ◽  
G. Hirsbrunner
Keyword(s):  
Titanium Alloy ◽  
Complete Healing ◽  
Lateral Side ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Subchondral Fracture ◽  
Medial Side ◽  
Internal Stabilization ◽  
Ligament Prosthesis

SummaryThe successful use of a collateral ligament prosthesis for stabilization of a transverse subchondral fracture of metatarsus III/IV in a newborn calf is reported. The proximal metaphysis of the right metatarsus III/IV was displaced medially with the medial collateral ligaments ruptured. On the medial side the periosteum was intact, whereas it was detached on the lateral side. The fracture was reduced and the collateral ligaments and the periosteum were reattached on the lateral side of the proximal metatarsus III/IV using titanium alloy staples. On the medial side a braided polypropylene yarn prosthesis, including the ruptured collateral ligaments was attached to the os tarsale II/III and the proximal metatarsus III/IV, using titanium alloy staples. The minimal internal stabilization was reinforced by a full limb fibreglass cast.Seven months after the operation clinical and radiographic follow-up examination revealed complete healing of the fracture without signs of ankylosis of the tarsometatarsal joint. The calf did not show any signs of lameness and axial alignment of the fractured bone in the frontal and sagittal plane was excellent.Subchondral fractures in calves have rarely been described. The case reported here deals with treatment of a subchondral fracture of metatarsus III/IV in a newborn calf. Open fracture reduction was followed by minimal internal stabilization, using a collateral ligament prosthesis, which was reinforced by external coaptation. Follow-up examination revealed complete healing of the fracture in good alignment.

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