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We have devised a reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal (MCP) joints. It comprises palmaris longus tendon grafting into a bone tunnel and suturing onto the base of the residual ligament without involving fixation of the tendon graft stump.

Thirteen patients were treated for injured MCP joints: thumb/ulnar, ten cases; thumb/radial, two; and middle finger/radial, one. All patients had pain and instability of average 41° in the affected MCP joints. The patients were followed at an average period of five years and nine months. Pain and joint instability disappeared in all patients. The mean MCP joint range of motion (ROM) was 1° on extension and 58° on flexion. The tip pinch strength averaged 4.8 kg.

The gratifying results obtained using this method are attributed to the fact that optimal tension of the ligament and satisfactory ROM can be achieved during the course of rehabilitation.

We report the outcome of a five-year follow-up after wrist arthroscopy and excision of painful dorsal wrist ganglia. The findings at the time of surgery have previously been published. Patients responded to a validated postal questionnaire regarding ganglion recurrence, wrist pain and function. None of the responding patients had recurrence of the ganglia since surgery but only one patient had remained pain free with normal function following surgery. Three of the remaining patients reported moderate to severe problems with work and four reported minimal work problems. Our findings suggest patients with arthroscopic confirmed ligament injuries leading to joint instability or localised osteoarthritis may develop functional disability but less severe injuries are unlikely to cause persistent problems in the short- to medium-term. Surgical excision of the ganglion can give lasting satisfactory cosmetic outcome despite persisting underlying ligament pathology.

Background: Management of grade III injuries of the radial collateral ligament (RCL) of the thumb is controversial. These injuries are often treated with early surgery. However, early surgery may not be practical for the professional athlete. We report on the outcome of delayed primary repair of chronic RCL injuries without the use of tendon grafts or tendon transfers.

Methods: Twelve elite professional athletes with 15 soft tissue RCL injuries who underwent delayed surgery (greater than 6 weeks) were included in this study. Athletes were managed with splinting and ongoing play during the sporting season, and underwent surgery at the conclusion of the season. Mean duration from injury to surgery was 5 months. Mean follow-up was 4.2 years after surgery. Patient-report outcome measures including pain, satisfaction rating, and disability of the arm, shoulder and hand (DASH) scores were collected. Examination findings including range of motion, laxity, and grip and pinch strength were also measured. Return-to-play data were collected for all athletes.

Results: The RCL was able to be primarily repaired with suture anchors in all cases. All twelve patients were able to return to competitive play at the same pre-injury professional level. Post-operative joint function such as range of motion and laxity were comparable to the unaffected contralateral side, as were grip and lateral pinch strengths. Tip-pinch strength is lower compared to the unaffected side, but is comparable to age and sex-matched reference group.

Conclusions: Delayed primary repair of the RCL is a viable option and results in satisfactory long-term outcomes. This option may be more preferable to the professional athlete who wishes to avoid surgery during the sporting season.