Surgical treatment of chronic instability of the metacarpophalangeal finger joint based on the intraoperative condition of the collateral ligament: Results of a single-center study with 7 years’ follow-up - 24/08/21

Doi : 10.1016/j.otsr.2021.102969

Matthieu Mazaleyrat ^a, Camilo Chaves ^a, Steven Roulet ^a, Jacky Laulan ^a, Guillaume Bacle ^a,^b,^⁎
^a Department of Orthopaedic Surgery, Hand Surgery Unit, Hôpital Trousseau, CHRU de Tours, Tours, France
^b UMR 1253 (iBrain), Inserm Unit, équipe Imagerie, Biomarqueurs, Thérapie (IBT), Université de Tours, Tours, France

^⁎Corresponding author at: Department of Orthopaedic Surgery, Hand Surgery Unit, Hôpital Trousseau, CHU de Tours, UMR 1253 (iBrain), Inserm Unit, équipe Imagerie, Biomarqueurs, Thérapie (IBT), Université de Tours, Tours, France.Department of Orthopaedic Surgery, Hand Surgery Unit, Hôpital Trousseau, CHU de Tours, UMR 1253 (iBrain), Inserm Unit, équipe Imagerie, Biomarqueurs, Thérapie (IBT), Université de ToursToursFrance

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Abstract

Background

Severe traumatic injuries to the collateral ligaments of the metacarpophalangeal (MCP) joints of the fingers are rare and often missed. There is no consensus on how to treat neglected, chronic, and symptomatic ligament tears. The two main options are ligament reinsertion and ligament reconstruction, but no criteria exist to help surgeons choose between them.

Hypothesis

The structure and intraoperative appearance of the collateral ligament can be used to select between reattachment and ligament reconstruction; when the ligament is repairable, effective reattachment with a suture anchor is possible in chronic forms more than 3months after the injury event.

Patients and methods

Thirteen patients (14 consecutive cases) who underwent surgical treatment for a traumatic complete symptomatic tear of an MCP joint collateral ligament that was at least 3months old were included retrospectively. Six patients (7 fingers) had been treated by anchor reinsertion (group A) and seven patients (7 fingers) by ligament reconstruction as described by Hsieh (group B). Clinical and radiographic assessment consisted of the QuickDASH questionnaire, measurements of strength and active range of motion of the MCP compared to the other hand, and AP and lateral radiographs over the MCP joint.

Results

Twelve patients (13 fingers) were reviewed after a mean follow-up of 84±49months. The mean QuickDASH was 4.7±5.4 for group A and 23.8±16.0 for group B (p=0.008). There was a significant decrease in the flexion/extension motion (64°/−6°) in group B relative to the healthy contralateral hand and group A fingers (p=0.012 and p=0.014). There were no visible degenerative joint lesions at the final assessment; however, three patients in group B had undergone revision surgery to address chronic pain. Two of them had a preoperative volar subluxation that was not corrected by the ligament reconstruction.

Discussion

When a ligament is determined to be repairable based on intraoperative findings, reinsertion on bone provides satisfactory and long-lasting stabilization of the MCP joint even if the procedure is not done immediately after the injury occurs. If it is not repairable and no preoperative volar subluxation is found, the ligament reconstruction technique described by Hsieh restores stability to the MCP joint in the medium term with no signs of degeneration.