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. 2025 Apr 18;17(4):e82539.
doi: 10.7759/cureus.82539. eCollection 2025 Apr.

Thumb Radial Collateral Ligament Reconstruction With Autologous Graft: A Technical Note

Konstantinos Mastrantonakis  1 , Georgios Kalinterakis  2 , Eleni Christodoulou  1 , Georgios Psilomanousakis  1 , Christos Yiannakopoulos  3   2
Affiliations

Thumb Radial Collateral Ligament Reconstruction With Autologous Graft: A Technical Note

Konstantinos Mastrantonakis et al. Cureus. .

Abstract

Several procedures have been described to restore range of motion and stability for chronic radial collateral ligament (RCL) injuries. Anatomical repairs are indicated for acute tears, while for neglected cases, several reconstruction techniques have been described. The purpose of this technical note is to present a detailed, modified surgical technique of treating a chronic RCL tear, using an autologous tendon graft placed in a triangular fashion using drill holes (keyhole technique).

Keywords: carpometacarpal joint instability; keyhole ligamentoplasty; ligament injuries; radial collateral ligament; thumb.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative images
A: Plain lateral radiograph showing volar displacement of the proximal phalanx in relation to the metacarpal. B. A dorsoradial prominence was noted at the metacarpophalangeal joint
Figure 2
Figure 2. Perioperative images - 1
A. The abductor aponeurosis was retracted volarly, and the joint capsule was incised. B. From two 1 cm incisions proximal and distal to the forearm, a 15 cm strip from the FCR tendon graft was harvested. C. The two tunnels were made at the base of the phalanx (about 5 mm from the articular surface) when viewed from the side of the right thumb, so they create a tunnel with a sufficient distance between them so that no bone is detached when the graft slides FCR: flexor carpi radialis
Figure 3
Figure 3. Perioperative images - 2
A. The sutures were connected to one end of the graft and passed sequentially, first through the phalanx tunnel. B. A small counter-incision was performed in the ulnar side of the metacarpal, and the suture ends were passed through the ulnar cortex of the metacarpal through an epidural catheter tube. C. Then, the radial end of the tendon graft was pulled with the metacarpophalangeal joint in an abducted position, flexed at 45 degrees
Figure 4
Figure 4. A. The graft limbs at the radial side were docked together with non-absorbable suture and tensioned to the metacarpophalangeal bone with a mini–suture anchor adjacent to the radial hole. The tendon graft was then secured with periosteal sutures in the graft tails at the ulnar cortex. B. The ulnar end of the tendon was folded back and sutured with non-absorbable sutures creating a plug
See this image and copyright information in PMC

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