Role of Vickers Ligament in the Pathogenesis of Madelung Deformity

Objective The Vickers ligament is thought to hinder the growth of palmar ulnar radius by tethering the lunate to the radius,leading to Madelung deformity.The purpose of this study was to clarify the nature of the Vickers ligament and investigate its pathogenesis in Madelung deformities based on our observation of the Vickers ligament.Methods All 22 patients(33 wrists)with Madelung deformities treated surgically between 2018 and 2022 were included.The diagnosis was confirmed radiographically in all patients.The three-dimensional computed tomography(3D-CT)data of 16 patients(19 wrists)were available.Magnetic resonance imaging(MRI)data were available for 9 patients(14 wrists).Wrist arthroscopy was used in 4 patients.The Vickers ligament was resected and submitted for histopathological examination in 8 patients.Radiographic outcomes,3D-CT,MRI,arthroscopy,surgical findings,and histopathology of the Vickers ligament were evaluated.Results The 3D-CT revealed that the Vickers ligament originated in the metaphysis and formed a metaphyseal defect at the palmar ulnar radius.In the sequential MR coronal images,the Vickers ligament could be divided into 3 branches,extending to the lunate,triquetrum and ulnar styloid.Arthroscopy and surgical findings revealed that the nature of the Vickers ligament was the stretched palmar ligament of the wrist.The histopathology results revealed ligamentous tissue and fibrocartilaginous metaplasia with a structure similar to that of the triangular fibrocartilage complex(TFCC).Conclusions The Vickers ligament is not a separate aberrant ligament.The nature of the Vickers ligament is a combination of the stretched TFCC ligament(palmar radioulnar ligament,ulnotriquetral ligament and ulnolunate ligament)and radiolunate ligament.The possible pathogenesis of Madelung deformity might be focal early epiphyseal closure at the middle part of the sigmoid notch,which leads to focal growth retardation of the radius and pulls palmar ligaments proximally to form the Vickers ligament.

Langenskiold Procedure for Madelung’s Deformity:Case Series of Late Sequelae

Background: Although many authors advise to postpone surgical intervention until skeletal maturity is reached, the Langenskiöld procedure—entailing physiolysis and the release of Vickers’ ligament—is a known procedure in case of Madelung’s deformity in children. Although advised in textbooks and recent reviews, the results and late sequelae of this procedure have been poorly documented. The aim of this study is to portray the late effects of this procedure for three patients and emphasize a very careful patient selection. Methods: A retrospective study was performed of the medical records of three patients who underwent a Langenskiöld procedure with release of Vickers’ ligament for Madelung’s deformity of the wrist. They were recalled for function evaluation and their results are presented in the current study. Results: We report the long term results of three patients (five wrists) who underwent a Langenskiöld procedure with release of Vickers’ ligament in detail. Mean follow-up was twelve years (range: 11 - 14 years). In all of the operated wrists severe pain recurred due to destruction of the distal radio-ulnar joint. Further salvaging surgeries were necessary, some with highly dissatisfying results. Conclusions: Based on our experience we advise not to perform this procedure until further studies have proven its effectiveness and clear indications. Other techniques are available for later correction of Madelung’s deformity, with similar results on pain relief, wrist function and cosmetics. However, we will advocate conservative treatment until skeletal maturity is reached.