title: Mechanics of an anatomical reconstruction for the thumb metacarpophalangeal collateral ligaments.
abstract: OBJECTIVE
  This study biomechanically evaluated a technically easy variation of anatomical reconstruction of the thumb metacarpophalangeal (MCP) joint ulnar (UCL) and radial (RCL) collateral ligaments. Based on previous work describing the anatomical origin and insertion of these ligaments, we hypothesized that, using these attachment points, joint stability would be restored without significant loss of MCP flexion.
  
  
  METHODS
  The collateral ligaments were isolated in 30 cadaveric thumbs (15 UCLs and 15 RCLs). A cyclical load was applied to the MCP joint to assess flexion, radial/ulnar deviation in neutral, and radial/ulnar deviation in 30° of flexion. The collateral ligaments were detached from the bone while their origin and insertion points were marked. Using these sites, anatomical ligament reconstruction was performed with a palmaris longus tendon graft and interference screw fixation. Cyclical testing was repeated on the reconstructed ligaments.
  
  
  RESULTS
  No significant difference was found between intact and reconstructed UCLs when tested for radial deviation in neutral, radial deviation in 30° of flexion, or total MCP flexion. No significant difference was found between intact and reconstructed RCLs when tested for ulnar deviation in neutral, ulnar deviation in 30° of flexion, or total MCP flexion.
  
  
  CONCLUSIONS
  Our anatomical reconstruction is simple and restores UCL and RCL anatomy as compared with current techniques in the literature by placing the origin and insertion at their anatomical points with use of an interference screw. Using these anatomical origins and insertions, we were able to restore the MCP flexion and stability seen in an intact ligament.
  
  
  CONCLUSIONS
  Our anatomical reconstruction offers a technically easy option for reconstruction of thumb MCP collateral ligament injuries, restoring joint stability without sacrificing flexion.
authors.affiliation: Hospital for Special Surgery, New York, NY 10021, USA. carlsonm@hss.edu
authors.forename: Michelle Gerwin
authors.initials: MG
authors.lastname: Carlson
authors.forename: Kristin K
authors.initials: KK
authors.lastname: Warner
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Meyers
authors.forename: Krystle A
authors.initials: KA
authors.lastname: Hearns
authors.forename: Peter L
authors.initials: PL
authors.lastname: Kok
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D017885:Collateral Ligaments / Q000293:injuries* / Q000502:physiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D013933:Thumb / Q000033:anatomy & histology / Q000293:injuries* / Q000503:physiopathology