Comparative Study of Spiral Oblique Retinacular Ligament Reconstruction Techniques Using Either a Lateral Band or a Tendon Graft

Background In the management of mallet deformities, oblique retinacular ligament (ORL) reconstruction provides a mechanism for automatic distal interphalangeal (DIP) joint extension upon active proximal interphalangeal joint extension. The two variants of ORL reconstruction utilize either the lateral band or a free tendon graft. This study aims to compare these two surgical techniques and to assess any differences in functional outcome. As a secondary measure, the Mitek bone anchor and pull-in suture methods are compared.

Methods A single-institutional retrospective review of ORL reconstruction was performed. The standard patient demographics, injury mechanism, type of ORL reconstruction, and pre/postoperative degree of extension lag were collected for the 27 cases identified. The cases were divided into lateral band (group A, n=15) and free tendon graft groups (group B, n=12). Group B was subdivided into the pull-in suture technique (B-I) and the Mitek bone anchor method (B-II).

Results Overall, ORL reconstructions had improved the mean DIP extension lag by 10° (P=0.027). Neither the reconstructive technique choice nor bone fixation method identified any statistically meaningful difference in functional outcome (P=0.51 and P=0.83, respectively). Soft-tissue injury was associated with 30.8° of improvement in the extension lag. The most common complications were tendon adhesion and rupture.

Conclusions The choice of the ORL reconstructive technique or the bone anchor method did not influence the primary functional outcome of extension lag in this study. Both lateral band and free tendon graft ORL reconstructions are valid treatment methods in the management of chronic mallet deformity.

Keywords

Finger injuries - Tendons - Reconstructive surgical procedures

This article was presented at the 70th Congress of the Korean Society of Plastic and Reconstructive Surgeons on November 9, 2012, in Seoul, Korea.

This study was also presented at the 30th Congress of the Korean Society for Surgery of the Hand on November 23, 2012, in Seoul, Korea.

Publication History

Received: 07 May 2013

Accepted: 23 July 2013

Article published online:
01 May 2022

• REFERENCES

• 1 Thompson JS, Littler JW, Upton J. The spiral oblique retinacular ligament (SORL). J Hand Surg Am 1978; 3: 482-487
• 2 Makhlouf VM, Deek NA. Surgical treatment of chronic mallet finger. Ann Plast Surg 2011; 66: 670-672
• 3 Ay S, Akinci M, Ercetin O. The Brooks and Graner procedure for treatment of chronic tendinous mallet finger deformity. Tech Hand Up Extrem Surg 2004; 8: 21-24
• 4 Chao JD, Sarwahi V, Da Silva YS. et al. Central slip tenotomy for the treatment of chronic mallet finger: an anatomic study. J Hand Surg Am 2004; 29: 216-219
• 5 Littler JW. The finger extensor mechanism. Surg Clin North Am 1967; 47: 415-432
• 6 Kim JW, Chung SM. Pull-in suture technique for the disinsertion of the phalangeal tendon distal insertion. J Korean Soc Plast Reconstr Surg 2008; 35: 723-728
• 7 Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001; 26: 908-915
• 8 Wehbe MA. Anatomy of the extensor mechanism of the hand and wrist. Hand Clin 1995; 11: 361-366
• 9 Shrewsbury MM, Johnson RK. A systematic study of the oblique retinacular ligament of the human finger: its structure and function. J Hand Surg Am 1977; 2: 194-199
• 10 Harris Jr C, Rutledge Jr GL. The functional anatomy of the extensor mechanism of the finger. J Bone Joint Surg Am 1972; 54: 713-726
• 11 Schweitzer TP, Rayan GM. The terminal tendon of the digital extensor mechanism: Part II, kinematic study. J Hand Surg Am 2004; 29: 903-908
• 12 Kleinman WB, Petersen DP. Oblique retinacular ligament reconstruction for chronic mallet finger deformity. J Hand Surg Am 1984; 9: 399-404