Reconstruction of the radial collateral ligament of the metacarpophalangeal joints of the fingers

Abstract

Background

Injury to the collateral ligament of the metacarpophalangeal (MP) joint is less common in the finger than the thumb and can have a significant impact on function. When it affects the middle finger, we have observed a more extensive mechanical disturbance than that affecting just the MP joint, and for the central two fingers with less accessible ligaments, we have developed a strong method of reconstruction using a tendon graft which also corrects the mechanical disturbance caused by loss of suspension of the assemblage nucleus which holds the flexor tendons and adjacent structures into the convexity of the transverse palmar arch.

Methods

Ten patients with painful chronic radial collateral ligament injuries of the MP joint of the finger were treated surgically. Eight of these patients received reconstruction using a tendon graft, whilst in one case, the ligament was reattached directly using a suture and in one by a tendon transfer.

Results

All patients achieved a good outcome following their surgery. Of the six patients treated with the described tendon graft technique, the average post-operative QuickDASH score was 0; the average post-operative grip strength, as a percentage of the unaffected good side, was 100 %, and the average active flexion, active extension, and passive extension were 83°, −8° and −24°, respectively.

Conclusions

For the middle and ring fingers, we recommend reconstruction using a tendon graft in order to restore the support to the whole flexor mechanism in the palm and to overcome the difficulty presented by inaccessibility of the ligament. Our cases treated in this way have shown full recovery of the function and correction of incipient deformity even when subluxation had started to occur.

Level of Evidence: Level V, therapeutic study.