|Beitragstitel||Collateral Ligament Reconstruction of the Proximal Interphalangeal Joint in Chronic Instability. Case Report and Description of Technique|
Chronic instability of the proximal interphalangeal joint (PIPJ) of the finger is a rare condition. Surgical treatment is necessary only in cases of failed conservative treatment or symptomatic instability.
Several operative techniques have been described. Chronic lesions leading to PIPJ instability can be treated by ligament reconstruction, tenodesis or joint fusion.
We introduce a new surgical method using a tendon autograft to reconstruct the collateral ligament of the PIPJ.
Case Report and Surgical Technique:
A 17 years old female patient presented with symptomatic posttraumatic chronic radial PIPJ instability of the index finger. Radiographs under lateral stress demonstrated a radial instability of more than 20°. Initial treatment included hand therapy and buddy taping to the adjacent finger, but conservative management failed and surgery was planned to reconstruct the ligament and to regain joint stability.
Our simple method positions the tendon autograft anatomically, corresponding the original course of the lateral collateral ligament and potentially also the accessory collateral ligament. Fixation of the graft is secured by a wire loop whilst Tendon-to-Bone healing is sought. With our method impairment of other dynamic stabilizers of the PIPJ is avoided and no wide drill holes are needed. Postoperative care consists of immobilization for a few days and then buddy taping for 6 weeks.
At 6 month postoperative the patient presented a stable PIPJ with full range of motion and reported no complaints of pain or instability. She resumed full daily activity.
We introduce a new surgical method using a tendon autograft to reconstruct the collateral ligament of the PIPJ in chronic instability. Our method avoids potential drawbacks of the previously reported techniques like disruption of the other dynamic stabilizers. Our method can be used not only to reconstruct the lateral collateral ligament but also the accessory collateral ligament and is suitable for revision surgery as well.