Hand & Handgelenk

Rekonstruktion des Daumenseitenbands mit dem 2,5-mm-PushLock®-Anker

Das rupturierte ulnare Kollateralband des Daumens wird mit einem Faden der Stärke 2-0 oder 0 vernäht. Das Öhr des 2,5-mm-PushLock-Ankers, mit dem die Fäden am Grund eines Bohrlochs fixiert werden, besteht aus PEEK. Der PushLock ermöglicht eine präzise Gewebespannung von Hand und eine Verankerung der Fäden durch Verklemmung des lamellenartigen Anteils. Sowohl der hochfeste, röntgendurchlässige Anker aus PEEK als auch der resorbierbare 2,5-mm-PushLock-Anker aus PLLA sorgen für eine optimale, knotenlose Gewebespannung und -fixierung. Zum Abschluss der Rekonstruktion kann der Operateur die gewünschte Fadenspannung ohne Knoten vornehmen. Dadurch werden Weichgewebereizungen über dem Material reduziert.&nbsp;
Weitere Einzelheiten zu dieser Operationstechnik finden Sie unter „Informationsmaterialien“.

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Hand, Wrist, and Elbow - Next Generation in Repair and Reconstruction

A step-by-step demonstration of how a product would (or could) be used in a surgical technique.

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2.5 mm PushLock® Knotless Suture Anchor

Portuguese (Português) - pt

Reparo/reconstrução do ligamento colateral do polegar com PushLock® de 2,5 mm/Bio-Tenodesis™ de 3 mm x 8 mm

Foot and Ankle

PushLock® de 2,5 mm - Âncora de sutura sem nós

Mike Hayton, MB ChB, (Wigan, England) presents solutions for acute and chronic thumb ulnar collateral ligament (UCL) repair. Dr. Hayton describes how the Mini PushLock® allows for repair of an acute tear. Both the Mini PushLock and the Tenodesis System for chronic tears provide a knotless solution for thumb UCL repair.

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Presentation Videos

Thumb Ulnar Collateral Ligament (UCL)

All right. Well, thank you for inviting me. So we're going to talk about some of the collateral ligament repairs and reconstruction. It's a pretty advanced audience, so we'll skip over some of these. But the steno lesion is where the ulnar collateral ligament flips out onto the wrong side of the adductor aponeurosis and and cannot therefore heal back down to its footprint because of the interposed aponeurosis. And it just will not heal and will cause chronic instability. They do need to be repaired. Otherwise the patient will have weak pinch grip. So we assess the thumb with tenderness over the ulnar collateral ligament. There's often a palpable lesion, and there's laxity. And there's no endpoint in full extension. And also in 30 degrees of flexion. I like to hold the metacarpal nice and stably and then apply a vulgar stress to it. And it'll open up as mentioned in extension and 30 degrees of flexion. We often perform plain radiographs to ensure there's not a bony avulsion. And remember that bony avulsions off the volar ulnar corner, and they're actually quite difficult to fix. Back on with a screw. And some people exercise them because you just can't fix them with with a screw. We perform stress x rays in certain situations under local anesthetic MRI scan. This is a rugby player and you can see on the right the huge muscle hypertrophy. And perhaps he's not entirely organic or free range. But that's perhaps another lecture. And he's got a small bony avulsion. Increasingly now we're starting to use ultrasound in our own outpatients. And if you've got a good ultrasonographer or you get to do it yourself, you can really identify the structures very clearly. And by flexing and extending the thumb IP joint, you can see the aponeurosis and the lesion flipped out onto the wrong side of it. And this is the yo yo sign where the the ligament becomes curled up on itself. This is an intraoperative picture. The spatula is going down underneath the adductor aponeurosis. And you can you can see in the bottom the ligament. And that really needs to sort of go down underneath the spatula. So what we simply do is incise the aponeurosis. And then we put a bone anchor into the footprint. And the footprint remember is slightly more volar. It's not in the mid axial line, it's slightly more volar. So I'll often supinate the thumb just to bring that volar surface up into view and put a bone anchor in place that's then repaired down. The more modern PushLock anchor is knotless. And I think this really does facilitate for a better repair. And when you've healed the adductor aponeurosis over the top, the tissue layers glide a lot better than having a really big, bulky knot. So in this case, with the PushLock you pre-drill a hole, you put the suture around the the ligament, put it down into place, and then just tap it home and it lies really nice and flush down to its footprint. I sometimes debride the area with a small blade and lift up the periosteum, just to give a roughened surface for appropriate implantation and good healing. Now, when I first started doing hand surgery. All these patients were put into a cast for six weeks. Kept completely still, and some people even put a wire across them. And you can bet that when you take that wire out and you take them out of a cast, that's six weeks. Boy, are they stable. In fact, they just don't even move their thumb MP joint. As with all things sports, medicine changes our practice. And I had a player that had to play in four weeks. It was the biggest game of his life and he needed to get moving. So what we did with him was start flexing and extending him. At one week we made him a radial blocking bar, a low profile thermoplastic splint that allowed him to play rugby in this, and it felt pretty solid once it was all taped up. So we then went on and did 16 with several years follow up in professional thumbs. So we get them flexing and extending at week one. And you can see we've got extremely good scores. We don't get them stiff. We get a very good kapandji scores and their pinch grip is symmetrical with the opposite side. We got them playing back. Of all those players back playing sport at 4.4 Four weeks as opposed to previously 6 or 8 weeks and with a stiff joint and we've got no ruptures. And then just the last couple of slides for a chronic ulnar collateral ligament. And we published the direct repair several years ago. Often in a chronic lesion. Careful dissection, you can lift up the old ligament and then just reattach it like you would as a primary repair. But if it's very matted and scarred down or the ligament isn't good and hasn't got good healing potential, you can then do a ligament reconstruction. And of course, the the books are all littered with all these drill holes figure of eight drill holes. And how many times have we done those? And we've snapped the bridge of the bone, which makes for a really bad day at the office. So my preferred technique now is using the three by eight millimeter Bio-Tenodesis screw, which is very simple, very quick and very fast and has got minimal risk associated with bone bridge breaking. Thank you.

German (Deutsch) - de

2.5 mm PushLock®/3 mm x 8 mm Bio-Tenodese™ – Refixierung und Rekonstruktion des ulnaren Seitenbandes am Daumengrundgelenk

Suture Anchor, 2.5 mm x 8 mm, Mini Bio-PushLock

Suture Anchor, Mini Bio-PushLock 2.5 mm x 8 mm

Anclaje de sutura, Mini Bio-PushLock, Ø 2.5 mm x 8 mm

DISPOSITIVO DE FIXACAO PUSHLOCK, 2.5 X 8MM MONTADO EM DISPOSITIVO INSERTOR E COM PONTA DE PEEK FECHADA.

Suture Anchor, 2.5 mm PEEK, Mini PushLock

Mini PushLock, 2.5 mm x 8 mm, VE5, steril, IM

Suture Anchor, PEEK Mini PushLock 2.5 mm x 8 mm

Anclaje de sutura, PEEK, Mini PushLock, Ø 2.5 mm x 8 mm

Âncora de sutura, PEEK Mini PushLock, 2.5 mm x 8 mm

2-0 FiberWire Suture, 18 in (Blue) w/Tapered Needle, 17.9 mm 3/8 circle, 12/box

2-0 FiberWire-Faden, blau, 46 cm, mit konischer Nadel, 17.9 mm, 3/8Kreis

2-0 FiberWire suture, blue, 46 cm, with tapered needle,17.9 mm, 3/8 circle

FiberWire de calibre #2-0, hilo de sutura de Polyblendtrenzado, azul,co

FIBERWIRE, BRAIDED PB, #2-0 BLUE W/NEEDLE

Sutura de polimistura entrançada FiberWi

0 FiberWire Suture, 38" (Blue) w/Tapered Needle, 22.2 mm 1/2 circle, 12/box

FiberWire #0, Geflochtener Polyblend Faden, Blau, mit spitzer Rundnadel, steril

FiberWire #0 Braided Polyblend Suture, Blue w/Tapered Needle

FiberWire de calibre #0, hilo de sutura de Polyblendtrenzado, azul, con

FIBERWIRE SIZE 0 SUTURE W/NEEDLES (TAPER)

Rekonstruktion des Daumenseitenbands mit dem 2,5-mm-PushLock^®-Anker

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Thumb Ulnar Collateral Ligament (UCL)

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Kataloge (1)

Hand, Wrist, and Elbow - Next Generation in Repair and Reconstruction

Operationsanleitungen (4)

2.5 mm PushLock® Knotless Suture Anchor

Reparo/reconstrução do ligamento colateral do polegar com PushLock® de 2,5 mm/Bio-Tenodesis™ de 3 mm x 8 mm

PushLock® de 2,5 mm - Âncora de sutura sem nós

2.5 mm PushLock®/3 mm x 8 mm Bio-Tenodese™ – Refixierung und Rekonstruktion des ulnaren Seitenbandes am Daumengrundgelenk

Presentation Videos (1)

Thumb Ulnar Collateral Ligament (UCL)

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AR-8825B

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AR-7220

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