Outcomes after Repair of Subacute-To-Chronic Grade III Metacarpophalangeal Joint Collateral Ligament Injuries in Fingers are Suboptimal

Abstract

Purpose Although injury to the collateral ligaments of the metacarpophalangeal joint (MPJ) of the fingers is less common than corresponding injuries in the thumb, similar disability may result from chronic untreated injuries. We evaluated injury characteristics and the outcome after primary repair of subacute to chronic grade III collateral ligament injuries of the MPJs of the fingers. Methods We retrospectively reviewed all patients who underwent primary repair of a finger MPJ collateral ligament over a 3-year period. Twenty-five digits in 23 patients with subacute to chronic injuries were identified, all of which had complete MPJ collateral ligament tear. Postoperatively, we assessed disability using DASH scores and evaluated joint stability, range of motion, and grip strength. These measures were compared to preoperative data to assess results. Post hoc analysis was used to compare the level of disability between index and small radial collateral ligaments and other finger CL injuries. Results Intraoperative findings revealed complete tears in all cases and all ligaments were of sufficient quality to permit primary repair using a suture anchor. The average preoperative DASH score was 40 (range 17-77) in 7 patients (nine fingers) where this was available. Postoperative DASH scores were available in 19 patients (21 fingers). The average postoperative DASH score was 19 (range 0-65). In the subgroup of patients with preoperative and postoperative DASH scores, there was no statistically significant difference after surgery (preop DASH 39.1 vs. postop DASH 23.8, p =0.17). The average grip strength as a percentage of the contralateral hand was 68 % (range 32-100 %). The average postoperative MPJ arc of motion was 75°(range 50-90°). Post hoc analysis showed statistically significant higher postoperative DASH scores among small finger RCL repairs compared to other finger CL repairs (p =0.007). Discussion Primary repair of complete MPJ collateral ligament injuries of the fingers may be performed in the subacute to chronic setting. Although joint stability was restored, patients continued to have decreased grip strength and residual disability.

28-year-old woman training fencing with isolated rupture of radial collateral ligament of the metacarpophalangeal joint of the index finger

“…In another described cases, in Grade III of tear surgical treatment resulted in good or suboptimal outcomes. After operation, there was recommended cast immobilization for two weeks and then rehabilitation to return full range of move in the joint [5,7,10,21]. In our case, knowing the mechanism of injury, there is recommended a method of preventing its renewed.…”

“…Isolated rupture of RCL of the MCP joint of the index finger is not clearly marked out in literature. Injuries of the fingers are rarely described [2,3,9,14,19,21,22]. On the other hand, there can be situation that the disorder was not diagnosed.…”

“…Certainly it concerns fencing players because of way of keeping foil, but it is possible another mechanism of the injury. It is very important to diagnose the disorder to minimize a risk of arthritis, debility and chronic loss of joint function [5,7,8,10,17,21][ 1 3 _ T D $ D I F F ] .…”

“…It seems to complete rupture of RCL of MCP joint of the index finger is underdiagnosed and in result underreported [12,15,20]. However, there are some effective operation techniques, which are one of the ways of treatment in every grade injuries [1,5,7,10,12,16,20,21]. From all patients with rupture of RCL of the MCP joint of the index finger reported in the orthopaedic literature, there is no cases about injuries acquired during sports activity.…”

Anatomical Study of the First Dorsal Interosseous Tendon for its Use as a Plasty of the Radial Collateral Ligament of the Index Metacarpophalangeal Joint

“…Injuries to the radial collateral ligament (RCL) of the index finger are scarcely reported in the literature, 1,2 and that makes some authors regard these injuries as underreported. 3,4 This fact may explain why there are more reports on the treatment of chronic injuries to this ligament 5,6 than on acute injuries. 2 The most commonly proposed treatment for these chronic injuries at the metacarpophalangeal joints is by means of a free tendon graft, 7 mainly the palmaris longus.…”