Radial collateral ligament (RCL) injuries account for 10-40% of collateral ligament injuries of the thumb metacarpophalangeal (MP) joint. [1] In acute tears, immobilization with plaster or splint is recommended. Complete tears are classified as grade 3 and denote a complete ligament tear with an absence of a solid end point on stress testing. In chronic grade 3 RCL injuries, a dorsoradial prominence occurs in the MP joint, resulting in weakness and pain during activity; the recent literature supports surgical treatment for this type of injury. [2] There are many surgical treatment options for chronic tears, including RCL soft tissue advancement, reconstruction with the abductor pollicis brevis (APB), and free tendon grafts. [3-5] In this study, we aimed to review our reconstruction method to treat chronic grade 3 thumb MP joint RCL tears using free tendon grafts. [6] PATIENTS AND METHODS This study was conducted at Haydarpaşa Numune Training and Research Hospital between May 2016 and July 2018. Adult patients who received a free tendon graft to treat chronic grade 3 thumb MP joint RCL injury were evaluated prospectively. Patients with incomplete bone maturation (n=1), those who had additional injuries in the same extremity (n=1), and Objectives: This study aims to review our reconstruction method to treat chronic grade 3 thumb metacarpophalangeal (MP) joint radial collateral ligament (RCL) tears using free tendon grafts. Patients and methods: Thirteen male patients (mean age 41 years; range, 20 to 67 years) who received a free tendon graft to treat chronic grade 3 thumb MP joint RCL injury between May 2016 and July 2018 were evaluated prospectively. Patients with incomplete bone maturation (n=1), those who had additional injuries in the same extremity (n=1), and those who had previously undergone surgery on the same extremity (n=1) were excluded. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used for functional evaluation and the visual analog scale (VAS) was also used for pain evaluation. Results: The decrease in DASH (p=0.008) and VAS (p=0.03) scores and the increase in grip (p=0.031) and pinch strength (p=0.006) between the preoperative and final follow-up values were statistically significant. No ulnar deviation was observed in X-rays at the final examination, nor was MP joint radial instability observed under ulnar stress during clinical examinations. In two patients, 1 and 1.5 mm palmar subluxation was observed at final examination. The other 11 patients had no palmar subluxation at final examination. Conclusion: Although ours is a more complicated method compared to other reconstruction approaches, we think that it is a suitable alternative for achieving joint stability and good functional results.