Radial Collateral Ligament Reconstruction with DX SwiveLock® SL by Damon Adamany, MD
Q: Performing a Radial Collateral Ligament (RCL) reconstruction with InternalBrace augmentation with the 3.5 DX SwiveLock SL is a new variation on what you have done in the past. Can you give us a brief overview of what you were doing and how you are changing your technique?
A: I was using the Arthrex 3 x 8 mm tenodesis screws with a palmaris graft for my reconstructions of both the radial and ulnar collateral ligaments of the thumb MCP joint. I still think that technique is solid and works well but have found a few differences that highlight some of the advantages of the new DX SwiveLock SL.
- On the radial side, I can incorporate 1.5 mm LabralTape as an InternalBrace augmentation for my biologic graft repair.
- I like the idea of not having any suture left behind on the ulnar side as I would normally have with using a 3 x 8 mm tenodesis screw technique. The blind tunnel technique of the 3.5 SwiveLock eliminates any concern I had about irritation from the small strand of suture left behind in the pull-through tenodesis technique.
- If LabralTape is used as an InternalBrace, you do not have to whipstitch or suture your graft. In addition to saving time, LabralTape gives the immediate strength to the construct while the soft tissue repair heals and incorporates.
- Lastly, there is no need to measure the graft length as is necessary with the standard tenodesis screw reconstruction technique. Tension is achieved by grabbing the tendon with the forked eyelet and bringing it down into the unicortical hole. Any remaining tendon can be cut flush to the bone.
Q: InternalBrace has been gaining popularity for a variety of techniques. Are you changing your post-op protocol to reflect the extra stability?
A: There were times in the past when I was concerned about repair strength or patient compliance and I would temporarily place a K-wire across the MCP joint to help protect the repair for a short period of time. These new techniques and anchors from Arthrex have allowed me to eliminate the need for a K-wire by internally bracing the repairs using 1.5 mm labral tape from Arthrex.
Q: Are there any other procedures that you see the 3.5 DX SwiveLock SL being used for?
A: The new 3.5 DX SwiveLock has allowed me to explore improving current techniques that we are using in the upper extremity. Recently, I had a perilunate dislocation with obvious scapholunate ligament rupture. Although I acutely repaired the ligament through drill holes using FiberWire, I worried that my repair might not heal or may not be strong enough. The amount of force per unit area that the ligament and joint see is extremely high and likely accounts for the high rate of failure for many of the techniques that we are trying to utilize to reconstruct and repair this ligament.
I repaired the ligament back to the footprint on the lunate through drill holes. I then protected my repair by internally bracing using 1.5 mm LabralTape from Arthrex. I utilized the new 3.5 DX SwiveLock by placing one in the superior proximal pole of the scaphoid, one in the lunate, and then finally one in the very distal, dorsal aspect of the scaphoid. By linking the two bones in this manner with an internal brace I hope to protect the repair long after I remove the K wires that were placed.
Q: Do you have anything further to add regarding the new 3.5 DX SwiveLock anchor from Arthrex?
A: It is nice to have the product on the shelf as a bailout option to help me if I run into trouble in a procedure. For instance, although I have not had to have the need to use it in this circumstance, there are definitely some people that are using the new anchor for CMC arthroplasty procedures. I certainly could see the anchor being useful if I had a catastrophic failure during my FCR tendon transfer. One could easily use a free graft and back it up with an internal brace in order to perform a suspensionplasty in that circumstance by utilizing the new Arthrex 3.5 DX SwiveLock anchor.