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

Abstract

BackgroundIn 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.MethodsA 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).ResultsOverall, 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.ConclusionsThe 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.

Treatment of chronic extensor tendons lesions of the fingers

“…First described by Thompson and Littler, it is derived from Littler's original technique of isolated ORL reconstruction using a slip of the lateral band. However, the original technique is difficult to carry out if the terminal tendon is discontinuous, such as in chronic mallet finger [42,43]. SORL acts as a dynamic tenodesis.…”

Fowler Central Slip Tenotomy or Spiral Oblique Retinacular Ligament Reconstruction? A Cadaveric Biomechanical Study in Swan-Neck Deformity

“…The proximal end of the graft was then separated while the distal end was left attached to the distal phalanx insertion. 8 After harvesting the graft, the remaining extensor mechanism was detached from the DIP to create a mallet deformity.…”

“…7 Both central slip tenotomy and SORL reconstruction are described for correcting a chronic mallet deformity with or without a supple swan-neck deformity. 5,8,9 Central slip tenotomy creates tension on the distal phalanx via the lateral bands. This procedure is mainly criticized because of a residual extension lag in the proximal interphalangeal (PIP) joint or even reversing the deformity creating PIP extension lag resulting in a boutonnière deformity.…”

“…5,12 The biomechanical basis of these reconstructions is unclear, and the use of these procedures relies on clinical experience. 1,8 The goal of this study is to biomechanically compare Fowler central slip tenotomy with SORL reconstruction using a lateral band in correcting a chronic mallet deformity as part of a swan-neck deformity.…”

Spiral oblique retinacular ligament reconstruction using lateral band technique to treat swan neck deformity due to chronic mallet finger: A case report

“…Swan neck deformity (SND) is characterized by hyperextension of proximal interphalangeal (PIP) joint and extension lag or flexion of distal interphalangeal (DIP) joint [ 1 , 2 ]. Patients with SND has a limitation of the overall function of the finger.…”