The supination effect of tendon transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis or longus: a cadaveric study.

Flexor carpi ulnaris (FCU) transfer to the extensor carpi radialis brevis (ECRB) and/or the extensor carpi radialis longus (ECRL) has been commonly used to provide wrist extension. The ability of this wrist extension transfer to also provide forearm supination has been inferred but not formally investigated. This laboratory study investigated the forearm supination effect of FCU transfer to the ECRB and to the ECRL in a cadaveric model. Two vectors of pull were investigated: freeing either the distal one third or the distal two thirds of the FCU ulnar origin. Five fresh-frozen, above-elbow, non-matched cadaveric specimens placed in a mounting device that allowed the arm to rotate about its ulnar axis starting from a full pronated position were measured for resultant supination after tendon transfer and loading. This study showed that the transfer of the FCU into either the ECRB or the ECRL resulted in no significant difference in maximum supination. The vector of origin, however, did significantly affect the maximum supination obtained. Releasing the distal two thirds of the FCU ulnar origin resulted in a mean supination that was significantly greater than the mean supination achieved with releasing the distal one third of the FCU ulnar origin. We concluded that in the cadaveric model, transfer of the FCU into either the ECRB or ECRL provided similar resultant supination and that freeing the distal two thirds of the FCU ulnar origin provided significantly more supination than freeing only the distal one third. For the hand surgeon treating wrist flexion in combination with forearm pronation deformity, transfer of the FCU into the ECRB and/or the ECRL can be used to concomitantly provide wrist extension and forearm supination.

Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation. A five-year follow-up study.

A prospective study was designed to provide 5-year followup of the treatment of isolated grade III sprains of the medial collateral ligament with early functional rehabilitation in 35 athletes. After injury, patients were placed in lateral hinged braces to provide valgus support without restricting flexion or extension of the knee. Treatment was initiated with range of motion exercises performed in a whirlpool or swimming pool. Patients were then started on quadriceps setting and leg raises. When 90 degrees of flexion was present, resistive exercises were added. Upon recovery, patients were allowed to return to unrestricted sports. Followup consisted of both questionnaires and physical examination and was graded on the 50-point Hospital for Special Surgery scale. Mean followup was 5.3 years (range, 2.5 to 8); mean Hospital for Special Surgery knee rating score was 45.9 points (range, 41 to 50). These results are comparable with those achieved with surgery or immobilization by earlier investigators. Thus, early functional rehabilitation treatment of complete medial collateral ligament sprains produces results comparable with those achieved with surgery or immobilization while minimizing treatment-related morbidity and allowing more rapid return to sports participation.

The effects of resection of the proximal part of the fibula on stability of the knee and on gait.

We studied six patients to determine the effects of unilateral marginal resection of the proximal part of the fibula on stability of the knee and on gait. At the time of the operation, the fibular collateral ligament and the tendon of the biceps femoris were reattached, but no attempt was made to stabilize the fibula otherwise. The patients were tested an average of sixty-one months after operation. Stability of the knee was measured with an instrumented system. Gait was evaluated with an optical electronic three-dimensional digitizing system and a multicomponent force-platform. The gait of six healthy control subjects of similar age was also studied, and the reproducibility of measurements of stability of the knee was investigated in four healthy adults. There were significant differences between the side on which an operation had been done and the contralateral side with regard to the extent of anterior translation and of total anterior-posterior translation of the tibia at both 20 and 90 degrees of flexion of the knee, and in total varus and valgus rotation of the knee (the number of degrees from a position of maximum varus to one of maximum valgus angulation) at 20 degrees of flexion. The measurements of gait and of motion of the knee were found to be normal when compared with those in the control subjects. In the ground-reaction measurements, there were some significant differences from normal in the medial-lateral plane, but they were clinically unimportant. Resection of the proximal part of the fibula can lead to instability of the knee.