Early Experience in Collateral Ligament Repair of the Hand with the use of a Novel Bio-Composite Scaffold: Technique and Outcomes

Abstract

Introduction Non-absorbable suture augmentation for collateral ligament reconstruction in the hand has been increasingly utilized to protect the reconstructed ligament while allowing early return activity and sport. Stress shielding, however, has been shown to affect the ultimate mechanical strength and composition of the reconstructed ligament, raising questions regarding the long-term consequences of this technique. The BioBrace is a bio-inductive scaffold composed of highly porous type I collagen and bioresorbable poly (l-lactide) microfilaments developed to provide time-zero protection following surgery, and a gradual decrease in stress shielding as it resorbs over the course of ligament healing. This study proposes a reproducible technique for the utilization of BioBrace for collateral ligament augmentation, and reports our experience and early outcomes using this novel implant. Materials and Methods A retrospective review of patients diagnosed with acute or chronic digital collateral ligament injuries who underwent surgical repair or reconstruction with BioBrace augmentation over a 4-year period (05/2022 to 01/2024) at a single institution. Patient charts were reviewed and demographic data, mechanism of injury, joint involvement, hand dominance, injury chronicity, radiographic and advanced-imaging (if obtained), were recorded. Pre- and postoperative QuickDash scores and Visual Analog Scale scores were compared. Postoperative clinical outcomes included clinical motion, pinch strength measurements were recorded. Results Thirteen patients were included with a mean age of 21 (15 - 49) years. Eleven (84.6%) of the patients included were high-level athletes. The mean QuickDash (QD) score improved from 81.5 preoperatively to 4.1 by 6 weeks postoperatively. The mean Visual Analog Scale pain score improved from 4.3 preoperatively to 0.6 postoperatively. There have been no reported failures, infection, radiographic osteolysis or radiographic evidence of loss of alignment. Two patients developed transient soft tissue reactions around the surgical incision, which were primarily erythema. Both resolved with adjustment of the splints. Return of range of motion was non-limiting and pinch grip strength was greater than 85% of the contralateral side by return to sport. Among the high-level athletes, nine (81.8%) returned to sport at eight weeks postoperatively, and all had returned to sport by 12 weeks. Discussion/Conclusion The BioBrace has distinct advantages over the non-absorbable constructs due its unique, innate biological and synthetic composition allowing for improved healing characteristics with increased strength. The decreased need for a large polymer anchor or nonabsorbable suture tape reduces complications related to osteolysis, fractures, soft tissue reactions, and late failure secondary to stress-shielding. Early outcomes highlight the implant’s efficacy in providing immediate protection while mitigating stress shielding concerns associated with non-absorbable constructs.