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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Are ligaments superior to tendons in reconstruction of injured ligaments in the hand?
Nayif Alnaif, MD; Susan Ge, MD; Salah Aldekhayel, MD, MSc; Teanoosh Zadeh, MD, FRCSC2
McGill University Health Center, Montreal, QC, Canada

Are ligaments superior to tendons in reconstruction of injured ligaments in the hand? Objectives: In the current literature, there is no consensus of using tendons vs. ligaments as a graft source. The aim of this review is to investigate and determine if one is more superior. Methods: A PubMed search was performed to find relevant articles exploring the properties of tendons and ligaments. Due to the paucity of articles discussing tendons and ligaments in the hands, wrist and upper limbs, articles discussing lower limbs were also included. Results: Although similar and often addressed as a single unit, tendons and ligaments display a number of significant differences. Tendons have a stiffer structure to hold muscle to bone whereas ligaments have a more elastic structure to allow for movement between bones. These roles are also reflected in their structure. Ligaments have a narrower crimp distance, ovoid cells, and a higher concentration of alpha smooth muscle associated with higher elasticity and tolerated strain. It has been shown that tendons undergo "ligamentization" when used to reconstruct limgaments. However, even after remodelling, important differences still persist, never reaching the functional status of the intact ligament. Conclusions: Long-term adverse outcomes after ligament reconstruction include decreased strength, mobility and graft rupture. The findings of this study reveal a theoretical advantage of using ligament grafts over tendon grafts to reconstruct injured ligaments. We hypothesize that these differences between tendons and ligaments even more important in the carpal bones where numerous ligaments are working together in synchrony. This indicates a need for further clinical studies to explore the long-term outcomes with direct comparison between the use of tendon and ligament.


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