Aims. Options for the treatment of intra-articular ligament injuries are limited, and insufficient ligament reconstruction can cause painful joint instability, loss of function, and progressive development of degenerative arthritis. This study aimed to assess the capability of a biologically enhanced matrix material for ligament reconstruction to withstand tensile forces within the joint and enhance ligament regeneration needed to regain joint function. Materials and Methods. A total of 18 New Zealand rabbits underwent bilateral anterior cruciate ligament reconstruction by autograft, FiberTape, or FiberTape-augmented autograft. Primary outcomes were biomechanical assessment (n = 17), microCT (µCT) assessment (n = 12), histological evaluation (n = 12), and quantitative polymerase chain reaction (qPCR) analysis (n = 6). Results. At eight weeks, FiberTape alone or FiberTape-augmented autograft demonstrated increased biomechanical stability compared with autograft regarding ultimate load to failure (p = 0.035), elongation (p = 0.006), and energy absorption (p = 0.022). FiberTape-grafted samples also demonstrated increased bone mineral density in the bone tunnel (p = 0.039). Histological evaluation showed integration of all grafts in the bone tunnels by new bone formation, and limited signs of inflammation overall. A lack of prolonged inflammation in all samples was confirmed by quantification of inflammation biomarkers. However, no regeneration of ligament-like tissue was observed along the suture tape materials. Except for one autograft failure, no adverse events were detected. Conclusion. Our results indicate that FiberTape increases the biomechanical performance of intra-articular ligament reconstructions in a verified rabbit model at eight weeks. Within this period, FiberTape did not adversely affect bone tunnel healing or invoke a prolonged elevation in inflammation. Cite this article: Bone Joint J 2019;101-B:1238–1247

Abstract. Introduction. We present a case series of patients that underwent knee ligament reconstruction with graft reinforcement using FibreTape (Arthrex), a 2mm wide non-biodegradable polyethylene tape. Outcomes and safety of this novel technique are reported. Methods. Data were collected from a prospectively maintained database from 03/2011 to 11/2019. All skeletally mature patients that underwent reinforced knee ligament reconstruction surgery at Basingstoke and North Hampshire Hospital were included. The cohort was interrogated for outcomes including failure, complications, and subjective patient reported outcomes at 6,12 and 24 months postoperatively. Results. 438 patients were eligible. The mean age was 33.4 years and 68% of them were males. This included 171 ACL reconstructions, 96 ACL with anterolatreal ligament reconstructions, 59 bicruciate reconstructions, 30 ACL with posterolateral corner, 49 posterior cruciate ligament with one other ligament and 33 other ligament reconstruction. Allograft was used for 125 patients. 338 cases related to primary reconstruction. The overall complication rate was 5.3%, with a 2.1% re-rupture rate. There were 9 patients with a re-rupture and 5 of them had undergone multiligament reconstruction. We found a statistically significant improvement in all subjective scoring indices post-operatively up to 2 years. There were no complications directly related to the use of ligament reinforcement. Conclusion. Graft reinforcement is a safe option in the management of knee ligament injuries. Encouraging results were observed in patient reported outcomes. Reinforcement is technically reproducible and may represent an answer for graft failure rates, especially in multiligament reconstructions. Further application and evaluation is necessary to confirm its benefit

Abstract. Objectives. The study aims to determine whether an arthroscopic ligament reconstruction is necessary to relieve clinical ankle instability symptoms in patients with an MRI scan showing medial or lateral ligament tear. Methods. This was a single centre retrospective case series study of 25 patients with ankle instability and ligament tear on MRI scan who had undergone arthroscopic procedures from January 2015 to December 2018. Patients were followed up for an average period of 3 years postoperatively to check for any recurrence of symptoms. Results. Of the 25 patients, 23 had ATFL tear on MRI scan, and 2 had deltoid ligament tear. Examination under anaesthesia was stable in 13 patients and unstable in 12 patients. The majority of the patients (76%) had a simple arthroscopic ankle debridement and no ligament repair. Six patients needed Brostrom repair. Conclusions. Our study has shown that in patients with MRI proven ligament tear and clinical instability, a ligament reconstruction was unnecessary in most patients. The instability symptoms of patients were relieved by simple ankle arthroscopic debridement

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) with the flexor carpi radialis (FCR) tendon is one of the most common procedures for the treatment of thumb carpometacarpal (CMC) arthritis. An alternative method involves trapeziectomy alone (TA). The trapeziectomy with LRTI procedure was developed to theoretically improve biomechanical strength and hand function when compared to TA, which leaves an anatomical void proximal to the first metacarpal. The LRTI procedure takes longer to perform and includes an autologous tendon graft. The goal of this retrospective cohort study was to evaluate the clinical outcomes of trapeziectomy with or without LRTI at a minimum follow-up of 1 year. A total of 43 adult patients who had underwent a total of 58 (TA=36, LRTI=22) surgical procedures for CMC arthritis participated in the study. This single surgeon retrospective cohort study sampled patients who underwent CMC arthroplasty with either TA or LRTI techniques between 2008 and 2020 with a minimum time of 1 year post-operatively. The patients were evaluated subjectively (The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire) and objectively (hand/thumb strength, pre/post-operative hand radiographs). Both the TA and LRTI procedures provided good pain relief, motion, strength, and stability without any severe complications. There was no statistically significant difference in hand or thumb strength between the two groups. Radiography showed that compared to the preoperative status, the trapezial space decreased similarly between the two groups. There was no difference in size of collapse between TA and LRTI post-operatively. The TA procedure had similar outcomes to LRTI and has the advantages of shorter surgical time, less incision length, and lower surgical complexity. TA provided equivalent trapezial space to LRTI after the operation. Future study should investigate these two procedures in a head-to-head comparison rather than longitudinally where both surgeon experience and time since procedure at follow-up may have impacted results

Introduction. Traditional treatment of idiopathic flatfoot in the adult population include calcaneal neck lengthening or fusions. These surgical methods result in abnormal function with significant complication rates. Our prospective study aimed to quantify the functional and radiological outcome of a new technique for spring ligament reconstruction using a hamstring graft, calcaneal osteotomy and medial head of gastrocnemius recession if appropriate. Methods. 22 feet were identified from the senior authors flatfoot reconstructions over a 3 year period (Jan 2013 to Dec 2015). 9 feet underwent a spring ligament reconstruction. The control group were 13 feet treated with standard tibialis posterior reconstruction surgery. Follow up ranged from 8 to 49 months. Functional assessment comprised VAS heath and pain scales, EQ-5D and MOXFQ scores. Radiographic analysis was performed for standardised parameters. Results. Each group contained two bilateral procedures. The spring ligament patients had a mean age of 43, BMI of 29 and a male to female ratio of 4;1 There were no statistical differences between groups starting point functional scores or pre-operative radiological deformity. Post-operatively there was a statistically significant improvement of all domains and overall MOXFQ, EQ5d and VAS in the spring ligament patients. There was a statistically significant improvement in all radiological parameters with all patients being returned to normal. Functional scores were not significantly better than the control group [MOXFQ components, Control vs spring ligament group, Pain: 42 vs 45 (p=0.71), Walking: 50 vs 56 (p=0.43), Social: 35 vs 39 (p=0.72), EQ-5D: 0.64 vs 0.70 (p=0.72)]. Spring ligament reconstruction produced statistically better deformity correction for 4 of 5 measured radiological parameters (p< 0.05). Conclusion. Our new method of spring ligament reconstruction restores normal anatomy. In comparison to traditional procedures our method provides equivalent functional results and improved deformity correction

Ten cases of missed Monteggia lesions were reviewed following treatment. Four cases were treated with an ulnar osteotomy, open reduction of radial head and annular ligament reconstruction (Group A). In six cases only an open reduction of the radial head was performed with an ulnar osteotomy (Group B). No annular ligament reconstruction was done in Group B. The mean age seven in both groups (range 4-12 years). The children presented three months to 24 months after the initial injury. Nine patients were classified as Bado type I, and one with Bado type III injury. The mean follow-up was 20 months (8-26 months) after surgery. In both groups the ulnar osteotomy healed uneventfully. In group A, there was one superficial infection, the mean loss of pronation was 12 degrees and in one case the radial head re-subluxed. In group B, the mean loss of pronation was 10 degrees. Elbow flexion was comparable to Group A. No radial head subluxation was seen in this group. No child in either group had any functional limitation in activities. Thus, in chronic Monteggia lesion, annular ligament reconstruction is not always required to restore radio-capitellar alignment. Open reduction of radial head with an ulnar osteotomy and stable fixation will suffice. Ligament reconstruction will not stabilise an inadequately reduced radial head

Introduction. Chronic ankle instability is a common condition that can be effectively treated with arthroscopic lateral ankle ligament reconstruction to restore ankle stability and function. The aim of this study was to assess the functional outcomes of arthroscopic lateral ligament reconstruction using the MOXFQ, VAS, and EQ5D patient-reported outcome measures (PROMs). Methods. This prospective series included 38 patients who underwent arthroscopic lateral ligament reconstruction for chronic ankle instability between December 2019 and April 2022. All patients completed the MOXFQ, VAS, and EQ5D PROMs preoperatively, as well as at6, and 12 months postoperatively. The MOXFQ is a disease-specific PROM that assesses foot and ankle function, while the VAS measures pain and the EQ5D evaluates health-related quality of life. Results. At the 12-month follow-up, the mean MOXFQ Index score had improved significantly from 53.3 ± 23.1 preoperatively to 16.0 ±21.1 (p < 0.001). Similarly, the mean VAS score had improved from 36.2 ± 22.4 preoperatively to 14.7 ± 15.0 (p < 0.001), and the meanEQ5D score had improved from 0.55 ± 0.26 preoperatively to 0.87 ± 0.12 (p < 0.001). No major complications were observed. Conclusion. Arthroscopic lateral ligament reconstruction is an effective treatment for chronic ankle instability, with significant improvements in clinical and health-related quality of life outcomes

Background. A randomised prospective study has already demonstrated that at 1-year follow-up, palmaris longus interposition or flexor carpi radialis (FCR) ligament reconstruction and tendon interposition do not improve the outcome of trapeziectomy for the treatment of painful osteoarthritis of the trapeziometacarpal joint. This study consisted of 183 thumbs in 162 women. Aims. 114 of the 183 thumbs have now completed their 5-year follow-up and this study reports their results. Patients and methods. The patients had been prospectively randomised for treatment by simple trapeziectomy without interposition or ligament reconstruction (T; n=45), trapeziectomy with palmaris longus interposition (T+PL; n=31) or ligament reconstruction and tendon interposition (T+LRTI; n=38) using 50% of the FCR tendon. Each patient had undergone assessments of thumb pain, stiffness and strength pre-operatively, at 3 months, at 1 year and after a minimum of 5 years post-operatively. Results. The three treatment groups were well matched for age and hand dominance. At the 5 year follow-up, 76% (T=80%; T+PL=71%; T+LRTI=76%) of the 114 patients had no pain or only mild pain after use. Thumb key pinch strengths at the 5 year follow-up did not differ significantly between the three procedures [T= 4.0 kg (95%CI, 3.6-4.4); T+PL= 3.6 kg (95%CI, 2.9-4.3); T+LRTI= 3.6 kg (95%CI, 3.1-4.1)]. The tip pinch strengths at 5 years were also similar after each of the operations [T= 2.7 kg (95%CI, 2.4-2.9); T+PL= 2.4 kg (95%CI, 1.9-2.9); T+LTRI= 2.5 kg (95%CI, 2.1-2.9)]. No cases of late deterioration were evident at 5 years. Conclusion. The outcomes of these three variations of trapeziectomy appear identical. Thus at 5 years, there appears to be no benefit to tendon interposition or ligament reconstruction

Background. Return to sports after anterior cruciate ligament reconstruction (ACLR) is multifactorial and rotational stability is one of the main concerns. Anterolateral ligament reconstruction (ALLR) has been recommended to enhance rotational stability. Purpose. To assess the effect of ALLR on return to sports. Study Design. Retrospective comparative cohort study;. Level of evidence: III. Methods. A total of 68 patients who underwent ACLR after acute ACL injury between 2015 and 2018 with a follow-up of at least 24 months were enrolled in the study. Patients with isolated ACLR (group ALL(-), n=41) were compared to patients with ACLR+ALLR (group ALL(+), n=27) in regard to subjective knee assessment via Tegner activity scale, Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, Knee Documentation Committee (IKDC) form and Lysholm score. All tests were performed before the surgery, at 6 months and 24 months postoperatively. Results. Mean follow-up was 29.7±2.9 months for group ALL(-) and 31.6±3.0 for ALL(+) (p=0.587). Tegner, ACL-RSI and IKDC scores at last follow-up were significantly better in ALL(+) compared to ALL(-). There were no significant differences in isokinetic extensor strength and single-leg hop test results between the groups. 40 (97.6%) patients in ALL(-) and 27 (100%) in ALL(+) had a grade 2 or 3 pivot shift (p=0.812) preoperatively. Postoperatively, 28 (68.3%) patients in ALL(-) and 25 (92.6%) patients in ALL(+) had a negative pivot shift (p<0.001). 2 (5.9%) patients in ALL(-) and 1 (3.7%) patient in ALL(+) needed ACLR revision due to traumatic re-injury (p=0.165). There was no significant difference in the rate of return to any sports activity (87.8% in ALL(-) vs 88.9% in ALL(+); p=0.532), but ALL(+) showed a higher rate of return to the same level of sports activity (55.6%) than group ALL(-) (31.7%) (p=0.012). Conclusion. ACLR combined with ALLR provided a significantly higher rate of return to the same level sports activity than ACLR alone, probably due to enhanced rotational stability

Instability of the thumb trapeziometacarpal joint is a major factor in the cause of degenerative disease. Surgically stabilized joint should be subject to less shear forces and hence, will be less likely to develop degenerative changes. The results of volar ligament reconstruction were assessed in 12 patients (8 men- 4 women). The average age at surgery was 35 years. All thumbs were radiographic stage I. All had failed conservative treatment with splinting and anti-inflammatory medication. Operativelly a strip of Flexor Carpi Radialis tendon was used for ligament reconstruction according to the technique described by Eaton, Glickel and Littler. The follow-up period averaged 7 years. At final follow-up 8 thumbs were stage I, 3 were stage II, and one was stage III. Ten patients were at least 90 % satisfied with the results of the surgery and only two had symptomatic thumb basal joint

Problem: Surgical technique and short term results of ligament reconstruction with trizeps tendon graft in posterolateral rotational instability of the elbow. Methods: From 2003 to 2006 posterolateral ligament reconstruction with a single strand trizeps tendon graft was performed in 38 patients with posterolateral instability of the elbow, mainly associated with refractory lateral epicondylitis. The reconstructions were performed with the original O Driscoll technique (6), interference screw fixation (30) and transfixation screw (2). There were no neurological complications, one superficial wound infection resolved by revision and 3 arthroscopic revisions for intraarticular scaring. The first 21 operated patients with a minimum follow up of twelve months were reviewed with a subjective 100 point rating score. Results: From 21 patients 4 could not be reached by letter or telephone, 2 patients were excluded for pre-operative stiffness and previous operations other than extensor release. 15 patients could be evaluated. Average follow up was 15,1, min 12, max 24 months. Patients satisfaction with the operation was rated very good by 6 patients (40%), good by 5 (33,3%) unchanged by 4 (26,7 %), none worsened. Mean postoperative score was 83/100 points. Mean score for pain was 22,2/30, for ADL 7,3/8, sleep 1,9/2, range of arm motion 9,2/10, extension 9,2/10, flexion 4,6/5, supination 4,7/5, pronation 4,2/5 and strength 20,1/25 points. Conclusion: Single strand posterolateral ligament reconstruction with a trizeps tendon graft in posterolateral instability of the elbow shows reliable short term results. More secure fixation is achieved with bone tunnel fixation and tenodesis or transfixation

The aim of this study was to evaluate the functional and clinical outcome following medial patello-femoral ligament reconstruction using autogenous hamstring tendon grafts for patellar instability. Over a 4 year period the senior author operated on 35 patients for lateral instability of the patella. The predominant initiating event was a sporting injury. Each patient had either failed conservative management including physiotherapy, or failed surgical management including tibial tuberosity transfer. Post-operatively, all patients were allowed full flexion and extension. Sporting activity was restricted until 4-6 months post-operatively. Patients were evaluated clinically and functionally. The Fulkerson score was utilised pre- and post-operatively. The minimum follow-up was 6 months, the mean follow-up was 20 months. There were 18 males and 17 females. The mean age was 24.6 years. The mean pre-operative Fulkerson score was 59.3 (range 6-100). The mean post-operative Fulkerson score was 83.6 (range 25-100), the mean improvement was 24.3. 24 patients returned to sporting activities. The main complications were one patient with a patella fracture that was stabilised with internal fixation, one patient requiring exploration and reinforcing the ligament which had attenuated. Both patients finally had a good clinical outcome. Our study has shown that symptomatic lateral instability of the patella can be effectively treated with a medial patello-femoral ligament reconstruction and result in overall good clinical and functional outcome. We would recommend this technique

Purpose: Trapezium excision and arthroplasty combined with ligament reconstruction as a treatment for first carpometacarpal joint arthritis is known to be associated with synovitis, prosthesis subluxation /dislocation and proximal migration of the metacarpal. To determine the effectiveness of our technique we used the objective and subjective outcome scores to assess the long term results. Methods: Ten patients (11 thumbs) underwent trapezium arthroplasty and ligament reconstruction procedure for grade III/ IV Eaton and Glickel arthritis. The FCR tendon was harvested split into half from proximal to its insertion site. The insertion site was left intact, the split tendon was passed through the first metacarpal base, passed along the radial side of the implant, through scaphoid and back to the 1st metacarpal as an entrapment technique. 7 female and 3 male patients with mean age of 53.9 comprised our series. Off the 10 patients 60% had surgery on their dominant hands. Results: All the patients had excellent results at a mean follow up of 33.5 months. The mean score (Buck-Gramco) for the tip pinch, grip strength and subjective score for pain, function and dexterity was comparable to the contra-lateral side. The mean tarpezial space ratio calculated from plain x-rays at the follow up was 0.37cm (p< 0.01)|There was evidence of synovitis, prosthesis subluxation or shortening of the thumb. Conclusions: This new method of securing the prosthesis does offer excellent results with good patient satisfaction

The comparison between surgical outcomes of trapeziectomy versus trapeziectomy with ligament reconstruction (LRTI) is well documented in the literature. We could not find any literature comparing these two procedures from a ‘patient-based outcome scoring’ perspective. The Patient Outcomes Of Surgery (POS) hand/arm questionnaire was used in order to assess the outcomes of 33 patients (23 Trapeziectomy and 10 LRTI). All surgery was carried out by the same hand surgeon. A telephone questionnaire was performed on each patient. The mean time post surgery was 15 months (range 1 to 27) and 20 months (range 7 to 30) for the Trapeziectomy and LRTI group respectively. There was statistically significant improvement in both groups for symptoms, physical activities and psychological functioning/cosmetic appearance. The Trapeziectomy alone group scored higher in all groups though this did not show statistical significance. There were statistically significant higher rates of complications in the LRTI group. LRTI surgery increased the tourniquet time by 28 minutes on average. Patient overall satisfaction was higher (85/100) in the trapeziectomy alone group than that of the LRTI group (75/100). Both trapeziectomy and trapeziectomy with LRTI offer a reliably way of treating arthritis of the carpometacarpal joint. In our study, Trapeziectomy alone resulted in better overall patient satisfaction with lower complication rates and reduced operating time

Acromioclavicular joint is an integral component of Shoulder Complex and common site of injury particularly for athletes involved in sports such as Football, Cricket, Rugby and Shotput. Acromioclavicular Injuries are often neglected and goes untreated especially in low demand patients. Classic surgical techniques are associated with high complication rates. This is a prospective study from 2015–2017 wherein 32 patients with Acute grade 3, 4, 5, 6 Acromioclavicular joint dislocations, were operated with Minimally Invasive Double Tunnel Anatomical Coraco-clavicular Ligament Reconstruction (DT-ACCLR) with Tightrope Suspensory fixation. Clinical Outcomes were evaluated with Visual Analog Scale, Constant functional scale, Start of Movement, Return to Work, Satisfaction index and Coraco-clavicular distance over 12 months. Mean follow-up was 14 ± 3.8 months. Visual analog scale and Constant scores revealed significant advancements 0 ± 0.5 (range, 0–2) and 95 ± 3 (range, 92–98) scores at 12 months respectively. The coraco-clavicular distance significantly reduced from 23 ± 2.4 mm to 8 ± 0.5 mm. Mean return to work by 7 days. 98.6% patients were satisfied with surgical results. We conclude that DT-ACCLR is simple and creative surgical technique which provides stable, reliable and painless AC joint. The patients can move the shoulder same day and return to Work by 5–7days and Sports 3–4 weeks

Purpose of study: The aim of this study was to look at the clinical outcome of PLC interference screws in knee ligament reconstruction surgery. Materials & Results: We prospectively followed up 60 patients who underwent primary anterior cruciate ligament (ACL) reconstructions using PLC (Calaxo; Smith & Nephew) screws to secure the graft in the tibial tunnel. [(35 male patients & 25 female). Average age 33.72 years]. In addition to the ACL, PLC screws were used to reconstruct the posterior cruciate ligament in one case and posterior cruciate ligament with the posterolateral corner in another three patients. Hamstring autografts were routinely preferred except in multiple ligament reconstructions, when allografts were also used. 25 (41.67%) patients presented with complications (synovitis in 10 patients, prominent tibial swelling in 21 patients and both in 7 patients). In comparison, no complications were noted in 60 other age and sex matched patients in whom PLLA (Bio RCI; Smith & Nephew) screws were used by the same surgeon. The symptoms in the PLC screw group often settled conservatively and did not affect knee stability. 6 patients underwent exploration of the tibial tunnel site. A sterile white cheesy substance was noted which was removed, leaving an empty tibial tunnel. The ACL graft was found to be well attached to tibial tunnel in all cases. The PLC screw size did not have any correlation to the occurrence of complications. 2 patients required multiple washouts, one of whom developed a deep infection. Conclusion: The degradation of PLC screws does not follow the gradual and controlled pattern demonstrated in the ovine model [Walsh WR et all, Arthroscopy. 2007 Jul;23(7):757–65. Comparison of PLLA and PLC interference screws in an ovine ACL reconstruction model.]. The unpredictable screw resorption, and the reaction to it can lead to serious clinical consequences

Introduction. The trapezio-metacarpal joint (TMCJ) is subject to constant multiplanar forces and is stabilised by the bony anatomy and ligamentous structures. Ligament reconstruction can correct the hypermobility and potentially prevent osteoarthritis. Eaton and Littler proposed a surgical technique to reconstruct the volar ligamentous support of this joint. In our cadaveric biomechanical study, we aimed to evaluate the resultant effect of this technique on the mobility of the thumb metacarpal. Materials and method. Seventeen cadaveric hands were prepared and placed on a custom-made jig. Movements at the trapeziometacarpal joint were created using weights. Static digital photographs were taken with intact anterior oblique (AOL) and ulnar collateral ligaments(UCL) and compared with those taken after sectioning these ligaments and following Eaton-Littler reconstructive technique. The photographic records were analyzed using Scion. Image™. Paired T-test was used to establish statistical significance with a p<0.05. Results. AOL and UCL stabilised the TMCJ in extension. Division of these ligaments produced a significant degree of subluxation of the metacarpal at this joint with the thumb in a neutral position. Reconstruction of the ligamentous supports, using the Eaton-Littler technique, reduced the degree of extension. Conclusion. The primary stabilising ligament of the TMCJ is a subject of debate. Our study objectively evaluates the effect of reconstruction of AOL and UCL on various movements at the TMCJ comparing with sectioned and unsectioned specimens. It confirms the role AOL and UCL in resisting extension and utility of the Eaton-Littler procedure in decreasing hyperextension at this joint. This may have clinical utility in traumatic injury and degenerative laxity, by reducing pain and potentially slowing or even preventing the progression of osteoarthritis

Abstract. Introduction. Historic MCL reconstruction techniques focused on the superficial MCL to restore valgus stability while overlooking tibial external rotation and the deep MCL. This study assessed the ability of a contemporary medial collateral ligament (MCL) reconstruction and a deep MCL (dMCL) reconstruction to restore rotational and valgus knee stability. Methods. Six pairs fresh-frozen cadaveric knee specimens with intact soft tissue were tested in four states: 1) intact 2) after sMCL and dMCL sectioning, 3) contemporary MCL reconstruction (LaPrade et al), and 4) dMCL reconstruction. In each state, four loading conditions were applied at varying flexion angles: 8Nm valgus torque, 5Nm tibial external rotation torque, 90N anterior drawer, and combined 90N anterior drawer plus 5Nm tibial external rotation torque. Results. Transection of the sMCL and dMCL resulted in increased laxity with valgus torque, external rotation torque, and combined anterior drawer plus external rotation. dMCL reconstruction restored external rotation stability to intact levels throughout all degrees of flexion but did not restore valgus stability at any flexion angle. Contemporary MCL reconstruction restored valgus and external rotation stability at 0° and 20° and valgus stability at 40°. In the combined anterior drawer plus tibial external rotation trial, the dMCL restored stability at 20° and improved stability between 40° and 90° flexion. Conversely, the contemporary MCL reconstruction did not restore stability at any degree of flexion. Conclusion. Deep MCL reconstruction restored rotational stability to the knee throughout range of motion but not valgus stability. The contemporary MCL reconstruction restored stability only near full extension

An unstable CMC I joint causes pain and dysfunction. Chronic subluxation can lead to cartilage damage and furthermore to rhizarthrosis. This study should evaluate the results of the Eaton Littler ligament reconstruction, in which a slip of the Flexor carpi radialis tendon (FCR) weaved through the basis of the first metacarpal and around the tendon of the Abductor pollicis longus and back to the FCR. Aftertreatment consists in 4 weeks cast, 4 weeks thermoplastic splint and physiotherapy, full opposition is allowed after 8 weeks. We performed 10 operations in 8 patients with a mean age of 35.9 years (6 female, 2 male). In 8 times the diagnosis was a rhizarthrosis Eaton Littler stadium I and in 2 times a posttraumatic instability. The mean follow up time was 15.4 months. We evaluated subjective satisfaction with the Disabilities of the Arm, Shoulder and Hand Score (DASH), pain with the visual analogue scale (VAS) and the patients were asked, if they would undergo the operation again. Furthermore the range of motion (ROM) was examined, the strengths (key and pin grip) were measured and radiographs were made. All patients would undergo the operation again. The mean DASH score was 17.4 points, the mean VAS in rest 0 and under stress 1.29. The mean pin grip strength was 3.98 kg and the mean key grip strength 7.14kg. The ROM was excellent with a mean anteposition of 39.5°, a mean abduction of 49.3°. The mean thumb opposition was Kapandji 9.9. Radiological there was no progression of the Eaton Littler stadium. As complications occurred 1 keloid and 1 hypaesthesia. Our experiences with the Eaton Littler procedure for stabilisation of the hypermobile thumb saddle joint were positive. Long time results will show, if the procedure can prevent cartilage damage and progression of rhizarthrosis

The management of scapho-lunate (SL) instability remains controversial. Since 2001, the senior author has used a modified Brunelli tenodesis to achieve soft tissue stabilization in patients presenting with dynamic or static SL instability. From 2001 to 2009, 13 patients were prospectively studied. All patients complained of painful clicking in the wrist, inability to use the wrist for loading activities, and all had a positive scaphoid shift test (Kirk Watson). Wrist arthroscopy was performed to confirm the diagnosis and to confirm the absence of degenerative change in all cases. Data collection pre-operatively included, range of motion, grip strength, DASH score and pain score. All patients had wrist immobilisation in a forearm cast for six weeks post operatively. Physiotherapy commenced at that stage and clinical assessment was performed at 3 months, six months and 12 months post surgery. Patients were discharged from follow-up after 12 months. A significant improvement in grip strength and DASH score was documented at the 12 month post operative assessment. The range of wrist flexion was decreased in all patients. The majority returned to their original employment. All patients reported that their wrist instability symptoms were improved. Conclusion. Scapho-lunate ligament reconstruction using a split flexor carpi radialis tendon graft to achieve soft tissue stabilization, provided satisfactory results in patients with chronic SL instability. Improvement in DASH score and grip strength were documented at one year follow-up