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Clinical Outcomes Following Revision Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Reconstruction with Autograft & Button Suspension
Emily Michelle Pflug, MD¹; Francisco Rodriguez Fontan, MD¹; Alexander Lauder, MD^1,2
1University of Colorado, Aurora, CO; ²Denver Health, Denver, CO

Introduction

Recurrent instability following thumb ulnar collateral ligament (UCL) repair or reconstruction may result in pain and poor function. Use of certain suture anchors during the index procedure may predispose patients to the development of osteolysis with subsequent fixation failure. We hypothesized that revision thumb metacarpophalangeal (MP) joint UCL reconstruction using local tendon autograft with suture button suspension would restore joint stability.

Materials & Methods

A retrospective review identified patients treated with this procedure at a single institution with a minimum of 3-months follow-up. This technique involves two opposing incisions along the thumb MP joint with sequential passing of local autograft and suture tape which is then fixated via suture-button suspension (Figure 1). Preoperative radiographs were evaluated for preexisting osteolysis. Patient demographics and clinical outcome measures including the visual analogue score (VAS) for pain, QuickDASH, and 12-Item Short Form Health Survey (SF-12) were collected. Descriptive statistics were performed.

Results

Three patients (1 male, 2 female) were included with a mean age of 44 years. The interval from the time of their initial procedure and subsequent reconstruction ranged from 7 weeks to 9 years. All patients had preoperative osteolysis from prior polyetheretherketone (PEEK) anchor placement. The average length of postoperative follow-up was 11 months (range 3-18). At final follow-up, all patients reported 0/10 VAS for pain with an average QuickDASH score of 13 (range 7-21). One patient reported intermittent irritation along the radial buttons; no other complications were reported (Table 1). No patients underwent secondary procedures including revision reconstruction or thumb MP joint fusion.



Conclusions

Preexisting osteolysis from prior PEEK anchor placement limits the reconstructive options for patients with recurrent instability of the thumb MP joint following primary repair or reconstruction of the UCL. Use of autograft fixated with suture-button suspension is feasible in the setting of bone loss as minimal footprint is required for the suture bridge. All patients achieved a stable thumb MP joint with minimal postoperative complications at an average of 11 months follow-up. This technique reliably restores joint stability and allows functional recovery with minimal postoperative complications.

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