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Isolated rupture of the lateral colateral ligament of the 1st MPJ

Discussion in 'Biomechanics, Sports and Foot orthoses' started by toomoon, Mar 27, 2014.

  1. toomoon

    toomoon Well-Known Member


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    Does anyone have any experience/ wisdom to share on this? I have an elite athlete who has suffered a stand-alone rupture of the lateral ligament of the 1st MPJ. No plantar plate involvement, nothing else on MRI. Athlete in multidirectional sport, and feels 1st MPJ is very unstable medially and dorsally in anything off straight line training 4 weeks out from the injury.
    Currently managed with a moulded brace with taping, followed by an orthotic with Morton's extension and medial wrap. Some progress with this, now introducing spacer between 1st/2nd and taping of medial 3 digits.
    Surgeon has reported unwillingness to repair... any ideas?
     
  2. Simon:

    If you mean an acute rupture of the medial collateral ligament of the 1st MPJ, which causes a relatively rapid onset of hallux abducto valgus deformity, then I just surgically repaired one of these about three weeks ago in a 24 year-old male who injured his 1st MPJ while rock climbing about 8 months ago. During surgery, I performed a modified Reverdin bunionectomy and found the tear in the medial collateral ligament and repaired it during the procedure. He is doing great so far. My opinion is that you need to find another surgeon who is more confident in their surgical skills since this should not be that difficult of a surgical procedure to do.
     
  3. Simon:

    Here's a few papers that you may want to look at.

    http://www.ncbi.nlm.nih.gov/pubmed/9356919



    http://www.ncbi.nlm.nih.gov/pubmed/11995833

     
  4. toomoon

    toomoon Well-Known Member

    I am afraid not.. it is the lateral ligament.. in isolation.. complete rupture.. I have never seen or indeed heard of one
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    We dealt with one few yrs ago in an AFL player ... nothing could do for it; they had local anesthetic injections for each game to finish season before surgical repair.
     
  6. toomoon

    toomoon Well-Known Member

    yep.. that is pretty much the way we are headed.. orthopod adamant he does not want to operate.. will continue as I have been, altho this is unusual because pain is not the issue.. there is virtually no pain.. just instability.
     
  7. If it is an isolated lateral collateral ligament tear of the 1st MPJ (I'll bet the lateral sesamoid ligament is also partially torn) the why not just tape the hallux to the forefoot to prevent the hallux from undergoing excessive internal rotation motion at the first MPJ until he can find a surgeon willing to operate on him. Any number of methods could be used to surgically repair it so it sounds like he needs to find a surgeon that feels comfortable doing such a procedure for this young athlete.
     
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