Grade III radial collateral ligament injuries of the thumb metacarpophalangeal joint: Treatment by soft tissue advancement and bony reattachment

Purpose: The purpose of this study is to report the results of intact radial collateral ligament (RCL) soft tissue sleeve advancement with bony reattachment without additional soft tissue reinforcement as the sole surgical repair technique for the treatment of grade III RCL injuries to the thumb metacarpophalangeal (MCP) joint in acute, chronic, and late cases. Methods: During a 20-year period, 38 of 45 patients (84%) with grade III RCL injuries were found to have tears at or adjacent to the metacarpal head (25 patients) or the proximal phalanx (13 patients) and underwent surgical repair at a mean of 10.8 months after injury. Patients were evaluated at a mean follow-up time of 3.8 years (minimum, 1 year), comparing pre- and postoperative standard thumb x-rays, varus (adduction) MCP joint stress x-rays, joint range of motion, pinch and grip strengths, clinical deformity, and subjective symptoms. Results: Thirty-three patients (87%) were symptom free. Thirty-five patients (92%) regained normal pinch and grip strength. Thirty patients (79%) had full range of motion at the MCP joint, and no patient lost any interphalangeal joint motion. No recurrent symptomatic MCP joint instability was noted. Three patients (8%) had mild residual asymptomatic MCP joint volar subluxation. One patient had progression of pre-existing degenerative joint changes. Conclusion: Acute, chronic, and late grade III RCL instability of the thumb MCP joint can be successfully treated in the majority of cases by RCL soft tissue sleeve advancement and bony reattachment alone without the need for other soft tissue reinforcement.