P D'Agostino1, F D Kerkhof2, M Shahabpour2, J-P Moermans2, F Stockmans2, E E Vereecke2. 1. Department of Development and Regeneration @ Kulak, Biomedical Sciences, KU Leuven, Belgium; Hand Clinic, Louise Medical Center, Brussels, Belgium; Europe Clinic, St-Elisabeth Clinic, Brussels, Belgium; Department of Radiology, UZ Brussel, Brussels, Belgium; Centre de Chirurgie de la Main, Clinique du Parc Léopold, Brussels, Belgium; HUDERF, ULB, Brussels, Belgium; Handgroep, AZ Groeninge, Kortrijk, Belgium. Electronic address: dagostinoprish@gmail.com. 2. Department of Development and Regeneration @ Kulak, Biomedical Sciences, KU Leuven, Belgium; Hand Clinic, Louise Medical Center, Brussels, Belgium; Europe Clinic, St-Elisabeth Clinic, Brussels, Belgium; Department of Radiology, UZ Brussel, Brussels, Belgium; Centre de Chirurgie de la Main, Clinique du Parc Léopold, Brussels, Belgium; HUDERF, ULB, Brussels, Belgium; Handgroep, AZ Groeninge, Kortrijk, Belgium.
Abstract
PURPOSE: The respective roles of the dorsoradial (DRL) and anterior oblique (AOL) ligaments in stability of the highly mobile trapeziometacarpal (TMC) joint remain disputed. Earlier publications have pointed to the AOL as the key stabilizing structure; yet, more recent publications have challenged the stabilizing role of the AOL, favoring the DRL as the main TMC joint stabilizer. We executed an anatomical study of the ligaments, including detailed dissection to quantify the length, width, and thickness of the AOL and DRL and tested the material properties of these ligaments. METHODS: Thirteen fresh frozen cadaveric thumbs from 9 specimens were used. Length, width, and thickness of the AOL and DRL were measured on magnetic resonance imaging and/or after dissection. Next, the first metacarpal and trapezium were isolated together with both ligaments, and both bones were cut sagittally to isolate a first metacarpal-AOL-trapezium and first metacarpal-DRL-trapezium complex from each thumb. These samples were subjected to cyclic loading in displacement-controlled tests. The obtained force-displacement curves were used to calculate stiffness and hysteresis of each sample. RESULTS: Our results showed that the DRL is significantly shorter and thicker than the AOL, which is thin and ill-defined. Our results also indicate that the DRL has a higher stiffness than the AOL, making it a more likely candidate to provide joint stability. CONCLUSIONS: Although the AOL has been asserted to be the primary restraint to dorsoradial subluxation, this view has been challenged over the past 10 years by several studies. These studies have shown the AOL to be relatively weak and compliant compared with the intermetacarpal and dorsoradial ligaments and have demonstrated that the DRL is the strongest and stiffest ligament of the TMC joint. Our studies confirm these findings. CLINICAL RELEVANCE: This study indicates that the DRL is relatively stiff and thick, suggesting it should be repaired or reconstructed when disrupted to restore stability of the TMC joint.
PURPOSE: The respective roles of the dorsoradial (DRL) and anterior oblique (AOL) ligaments in stability of the highly mobile trapeziometacarpal (TMC) joint remain disputed. Earlier publications have pointed to the AOL as the key stabilizing structure; yet, more recent publications have challenged the stabilizing role of the AOL, favoring the DRL as the main TMC joint stabilizer. We executed an anatomical study of the ligaments, including detailed dissection to quantify the length, width, and thickness of the AOL and DRL and tested the material properties of these ligaments. METHODS: Thirteen fresh frozen cadaveric thumbs from 9 specimens were used. Length, width, and thickness of the AOL and DRL were measured on magnetic resonance imaging and/or after dissection. Next, the first metacarpal and trapezium were isolated together with both ligaments, and both bones were cut sagittally to isolate a first metacarpal-AOL-trapezium and first metacarpal-DRL-trapezium complex from each thumb. These samples were subjected to cyclic loading in displacement-controlled tests. The obtained force-displacement curves were used to calculate stiffness and hysteresis of each sample. RESULTS: Our results showed that the DRL is significantly shorter and thicker than the AOL, which is thin and ill-defined. Our results also indicate that the DRL has a higher stiffness than the AOL, making it a more likely candidate to provide joint stability. CONCLUSIONS: Although the AOL has been asserted to be the primary restraint to dorsoradial subluxation, this view has been challenged over the past 10 years by several studies. These studies have shown the AOL to be relatively weak and compliant compared with the intermetacarpal and dorsoradial ligaments and have demonstrated that the DRL is the strongest and stiffest ligament of the TMC joint. Our studies confirm these findings. CLINICAL RELEVANCE: This study indicates that the DRL is relatively stiff and thick, suggesting it should be repaired or reconstructed when disrupted to restore stability of the TMC joint.
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