Reconstruction of chronic thumb metacarpophalangeal joint radial collateral ligament injuries with a half-slip of the abductor pollicis brevis tendon.
OBJECTIVE
To evaluate a reconstructive method for chronic radial collateral ligament (RCL) injuries of the thumb metacarpophalangeal (MCP) joint using a combination of RCL advancement and the transfer of a half-slip of the abductor pollicis brevis tendon.


METHODS
Eight patients (4 male and 4 female; mean age, 25 y) with chronic RCL injury of the thumb MCP joint were enrolled. All patients were referred to our institution because of continuing pain and instability on the radial side of the MCP joint when grasping or pinching objects. The mechanism of the injury was adduction stress to the thumb during sporting activities in 5 patients, a heavy object falling on the thumb in 1, and a fall in 2. The mean duration from RCL injury to surgery was 20 weeks. The average postoperative follow-up was 51 months. We evaluated postoperative outcomes including pain, range of motion of the thumb MCP joint, grip strength, key pinch strength, Disabilities of the Arm, Shoulder, and Hand score, and ability to return to preinjury work or sporting activities.


RESULTS
No patients demonstrated continuing symptoms, and the MCP joint was stable after surgery. Postoperative grip and pinch strength (37 and 6.3 kg, respectively) were increased compared with preoperative values (34 and 3.9 kg, respectively). All patients returned fully to their preinjury work or sporting activities within 6 months after surgery. Although postoperative flexion was decreased by an average of 6°, no patients noted functional deficiency.


CONCLUSIONS
We recommend the reconstructive method of RCL advancement and transfer of a half-slip of the abductor pollicis brevis tendon to alleviate pain and improve grip and pinch strength in chronic RCL injuries of the thumb MCP joint.
Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan. Electronic address: iba@sapmed.ac.jp.
Kousuke
K
Iba
Takuro
T
Wada
Tetsuro
T
Hiraiwa
Kohei
K
Kanaya
Gosuke
G
Oki
Toshihiko
T
Yamashita
D000293:Adolescent; D000328:Adult; D017885:Collateral Ligaments / Q000293:injuries* / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000293:injuries* / Q000601:surgery*; D010147:Pain Measurement; D019651:Plastic Surgery Procedures / Q000379:methods*; D013709:Tendon Transfer / Q000379:methods*; D013933:Thumb / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome
Abductor pollicis brevis; metacarpophalangeal joint; radial collateral ligament; reconstruction; thumb