Wang Kemble K, Boyce Glenn, Peters Tracy, Anderson Hamish, Hoy Greg
* Upper Limb Surgery Division, Melbourne Orthopaedic Group, Melbourne, Australia.
† Department of Orthopaedic Surgery, Austin Hospital, Melbourne, Australia.
J Hand Surg Asian Pac Vol. 2019 Jun;24(2):138-143. doi: 10.1142/S2424835519500176.
Management of grade III injuries of the radial collateral ligament (RCL) of the thumb is controversial. These injuries are often treated with early surgery. However, early surgery may not be practical for the professional athlete. We report on the outcome of delayed primary repair of chronic RCL injuries without the use of tendon grafts or tendon transfers. Twelve elite professional athletes with 15 soft tissue RCL injuries who underwent delayed surgery (greater than 6 weeks) were included in this study. Athletes were managed with splinting and ongoing play during the sporting season, and underwent surgery at the conclusion of the season. Mean duration from injury to surgery was 5 months. Mean follow-up was 4.2 years after surgery. Patient-report outcome measures including pain, satisfaction rating, and disability of the arm, shoulder and hand (DASH) scores were collected. Examination findings including range of motion, laxity, and grip and pinch strength were also measured. Return-to-play data were collected for all athletes. The RCL was able to be primarily repaired with suture anchors in all cases. All twelve patients were able to return to competitive play at the same pre-injury professional level. Post-operative joint function such as range of motion and laxity were comparable to the unaffected contralateral side, as were grip and lateral pinch strengths. Tip-pinch strength is lower compared to the unaffected side, but is comparable to age and sex-matched reference group. Delayed primary repair of the RCL is a viable option and results in satisfactory long-term outcomes. This option may be more preferable to the professional athlete who wishes to avoid surgery during the sporting season.
拇指桡侧副韧带（RCL）Ⅲ级损伤的治疗存在争议。这些损伤通常采用早期手术治疗。然而，早期手术对职业运动员来说可能并不实际。我们报告了在不使用肌腱移植或肌腱转移的情况下对慢性RCL损伤进行延迟一期修复的结果。本研究纳入了12名患有15处软组织RCL损伤且接受延迟手术（超过6周）的精英职业运动员。运动员在赛季期间采用夹板固定并继续比赛，并在赛季结束时接受手术。从受伤到手术的平均时间为5个月。术后平均随访4.2年。收集了包括疼痛、满意度评分以及手臂、肩部和手部功能障碍（DASH）评分等患者报告的结果指标。还测量了包括活动范围、松弛度以及握力和捏力等检查结果。收集了所有运动员的重返比赛数据。在所有病例中，RCL均能够使用缝合锚钉进行一期修复。所有12名患者均能够以受伤前相同的职业水平恢复竞技比赛。术后的关节功能，如活动范围和松弛度，与未受影响的对侧相当，握力和侧捏力也是如此。与未受影响的一侧相比，指尖捏力较低，但与年龄和性别匹配的参照组相当。RCL的延迟一期修复是一种可行的选择，并能带来令人满意的长期结果。对于希望在赛季期间避免手术的职业运动员来说，这种选择可能更可取。
