The clinical implications of the oblique retinacular ligament

Abstract

The oblique retinacular ligament originates from the flexor tendon sheath, courses past the proximal interphalangeal joint, and merges with the lateral extensor tendon. There has been disagreement regarding the contribution of the oblique retinacular ligament to coordinated movements between the proximal and distal interphalangeal joints. Landsmeer postulated that it acts as a dynamic tenodesis that tightens with proximal interphalangeal joint extension, causing obligatory distal interphalangeal joint extension. However, studies have shown that the oblique retinacular ligament is variably present and often attenuated, which diminishes its presumed role in finger movement. Despite this, the concept of a checkrein linking interphalangeal joint motion heralded the development of effective and reproducible surgical interventions for swan-neck and mallet deformities. This article examines the controversy regarding the existence of the oblique retinacular ligament, its plausible functionality, and clinical implications in the practice of hand surgery.

Keywords: Oblique retinacular ligament; mallet finger; swan-neck.

Figure 1

Drawing of the digital extensor mechanism with traction on the ORL. (Reprinted with permission from Strauch RJ. Extensor Tendon Injury. In: Green DP, Hotchkiss RN, Pederson WC ed. Green’s Operative Hand Surgery. 5th ed. New York, NY: Churchill Livingstone; 2005:163.)

Figure 2

The SORL technique. The spiral course of the graft ensures a volar position at the PIP joint and dorsal position at the DIP joint (Reprinted with permission from Thompson JS, Littler JW, Upton J. The spiral oblique retinacular ligament (SORL). J Hand Surg Am. 1978;3(5):482–487.)

Figure 3

Kleinman and Petersen’s modification of Thompson’s SORL technique to address passively correctable mallet deformities (© 2005 American Academy of Orthopaedic Surgeons. Reprinted from the Journal of the American Academy of Orthopaedic Surgeons, Volume 13(5), pp. 336–344 with permission. This figure was adapted by the AAOS with permission from J Hand Surg (Am) 1984;9:399–404.