Outcomes of Acute Operative Repair of Complete Digital Proximal Interphalangeal Joint Collateral Ligament Ruptures: A Systematic Review

Shifting the paradigm: ankylosis arthroplasty for the proximal interphalangeal joint with a novel collateral ligament reconstruction

Silicone arthroplasty for proximal interphalangeal joint ankylosis is rarely performed, partly due to the potential for lateral joint instability. We present our experience performing proximal interphalangeal joint arthroplasty for joint ankylosis, using a novel reinforcement/reconstruction technique for the proper collateral ligament. Cases were prospectively followed-up (median 13.5 months, range 9-24) and collected data included range of motion, intraoperative collateral ligament status and postoperative clinical joint stability; a seven-item Likert scale (1-5) patient-reported outcomes questionnaire was also completed. Twenty-one ankylosed proximal interphalangeal joints were treated with silicone arthroplasty, and 42 collateral ligament reinforcements undertaken in 12 patients. There was improvement in range of motion from 0° in all joints to a mean of 73° (SD 12.3); lateral joint stability was achieved in 40 out of 42 of collateral ligaments. High median patient satisfaction scores (5/5) suggest that silicone arthroplasty with collateral ligament reinforcement/reconstruction should be considered as a treatment option in selected patients with proximal interphalangeal joint ankylosis.Level of evidence: IV.

Midterm clinical outcomes of collateral ligament repair of the thumb and lesser digits: a retrospective analysis of 35 cases

Background

Finger collateral ligament injuries are common, and conservative treatment usually works well. However, complete ruptures that lead to instability could cause painful disability. This study presents our clinical experience and a qualitative functional evaluation following the surgical repair of the thumb and proximal interphalangeal (PIP) joint collateral ligament ruptures.

Methods

Thirty-five patients (22 men and 13 women), diagnosed via a physical examination and magnetic resonance imaging (MRI) with a total collateral ligament rupture in the metacarpophalangeal thumb (16) and PIP joints of the lesser digits (19) and treated surgically, were evaluated retrospectively. The limited range of motion; functional score by Saetta; disabilities of the arm, shoulder, and hand (DASH) score; pre- and post-operative pain, deformity level; and post-operative ability to grip keys, buttons, and jars were measured. The significance of the change between the pre and post-operative visual analog scale for pain (VAS) scores were evaluated using the Wilcoxon signed-rank test. The difference between the lesser digits and thumb groups by patient age was evaluated using the Mann–Whitney-U test. All data, such as the mean, range, and standard deviation, were calculated using SPSS.

Results

The mean pre- and post-operative VAS scores were 4.8 (from 3 to 7) and 0.91 (0 to 4), respectively. The mean post-operative limitation in the range of motion was 9.78° (s = 14.47) for lesser digits and 6.87° (s = 12.29) for the thumb. According to Seatta et al., the final functional score was 62.5% excellent, 25% good, and 12.5% moderate for the thumb and 84.2% excellent, 10.5% good, and 5.3% poor for the lesser digits. The mean post-operative DASH score was 13.55 (SD: 8.77) for lesser digits and 14.22 (SD: 8.9) for the thumb. The mean contralateral (healthy) hand DASH score was 0.75 (SD: 1.05) for lesser digits and 0.75 (SD: 1.05) for the thumb. For the thumb and lesser digits, the z-scores were − 3.55 and − 3.787, respectively, and the progress of the VAS score was significant (p < 0.05).

Conclusion

After a 40-month follow-up for 35 acute, subacute, and chronic cases, the results suggest that direct and suture-anchor repairs are feasible, painless treatments associated with good finger function.