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. 2023 Dec;48(11):1151-1158.
doi: 10.1177/17531934231187813. Epub 2023 Jul 13.

Satisfactory thumb metacarpophalangeal joint stability after ligament reconstruction with flexor digitorum superficialis in children with radial longitudinal deficiency

Ida Neergård Sletten  1 , Jarkko Jokihaara  2   3 , Anne Birgit Stavenes  1 , Mona Irene Winge  1
Affiliations

Satisfactory thumb metacarpophalangeal joint stability after ligament reconstruction with flexor digitorum superficialis in children with radial longitudinal deficiency

Ida Neergård Sletten et al. J Hand Surg Eur Vol. 2023 Dec.

Abstract

We investigated thumb joint stability and patient-reported and functional outcomes a minimum of 1 year after flexor digitorum superficialis opponensplasty and ligament reconstruction in 23 thumbs of 20 consecutive children with radial longitudinal deficiency. In total, 15 thumbs had preoperative multidirectional instability in the metacarpophalangeal joint. We reconstructed 22 ulnar and 16 radial collateral ligaments. At follow-up, all the metacarpophalangeal joints were stable ulnarly. Seven metacarpophalangeal joints were unstable radially despite ligament reconstruction but had no related complaints. We recommend the flexor digitorum superficialis opponensplasty as a safe and reliable procedure in hypoplastic thumbs to create stability and augment thumb strength.Level of evidence: IV.

Keywords: Congenital thumb hypoplasia; flexor digitorum superficialis; ligament reconstruction; opponensplasty.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The flexor digitorum superficialis tendon from the ring finger (FDS-ring) is detached distally and pulled proximal to the wrist level. It is secured by a pulley (here: the flexor carpi ulnaris loop) and passed subcutaneously to the thumb. The tendon is inserted into the distal dorsoradial part of the thumb metacarpal with the thumb in maximal palmar abduction with the wrist extended 20°. Illustration: A. Lødrup.
Figure 2.
Figure 2.
The flexor digitorum superficialis tendon from the ring finger (FDS-ring) is secured with osteosutures into the distal dorsoradial aspect of the thumb metacarpal just proximal to the pre-drilled mid-axial first metacarpal head bone tunnel. The tendon splits are separated, and the ulnar one is passed through the tunnel. Both splits are anchored to periosteal slits in the metaphysis of the proximal phalanx and doubled back over the joint and attached to themselves to reinforce the reconstruction. Illustration: A. Lødrup.
Figure 3.
Figure 3.
Assessment of the first web and the thumb joints before operation and at follow-up. CMCJ: carpometacarpal joint; IPJ: interphalangeal joint; MCPJ: metacarpophalangeal joint; RCL: radial collateral ligament; UCL: ulnar collateral ligament.
See this image and copyright information in PMC

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