Radial Collateral Ligament (RCL) Reconstruction Thumb Metacarpo-Phalangeal Joint (MCP Joint)

Collateral ligaments are necessary for lateral stability of  joints. They are particularly important in thumb metacarpo-phalangeal joints for stable pinch and grasp. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial collateral ligament should be performed.


Photograph demonstrating the left thumb of a patient with a torn radial collateral ligament (RCL) of the metacarpi-phalangeal joint (MCP). There is tenderness and prominence on the dorsal radial aspect of the head of the thumb metacarpal.






This view shows how unstable the metacarpo-phalangeal joint is with radial stress and ulnar deviation revealing a torn RCL of the MCP joint.







The proximal phalanx of the thumb should stay in line with the longitudinal axis of the metacarpal when stress is applied to it. This demonstrates instability secondary to a RCL sprain.







This X-Ray demonstrates volar subluxation of the thumb MCP joint secondary to the torn RCL and dorsal joint capsule.








Oblique view also showing the incongruity and subluxation of th the MCP joint.








The palmaris longus tendon is harvested to be used as a tendon graft to reconstruct the RCL since complete avulsion and shortening of the native ligament precluded primary repair.







This close up view of the MCP joint of the thumb reveals complete disruption of the RCL.








The palmaris longus tendon graft has been used to reconstruct the RCL by passing it through two drill holes creating a cortical bridge at the radial base of the proximal phalanx and inserted into the dorsal radial aspect of the head of the metacarpal.







Close up view. The graft is placed in a figure of eight fashion.









Another view of the same.