Treatment of Sagittal Band Injuries and Extensor Tendon Subluxation: A Systematic Review

Abstract

Background: This systematic review assesses the current literature and reviews the clinical outcomes of treatment for sagittal band injuries and extensor tendon instability. Materials: A systematic search of MEDLINE, EMBASE, and the Cochrane databases was performed for English-language articles on the treatment of nonrheumatoid adult sagittal band injuries between 1969 and 2019. Two independent reviewers were involved in screening, data extraction, and critical appraisal. The level of evidence was assigned using the Sackett scale, and the methodological quality of the studies was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Outcome measures were persistent pain, extensor lag, and recurrent tendon subluxation. Results: In all, 1653 abstracts were identified, with 43 articles reviewed in full text and 17 articles (429 treated digits) included in the final systematic review. There were 10 studies on surgical management, 3 on nonoperative management, and 4 on both. There were 4 retrospective case series and 13 retrospective case reports (Sackett level 4) with an average SEQES score of 15 (low quality). Studies on nonoperative management had on average more digits per study and higher SEQES scores (n = 27.7, SEQES = 19) compared with studies on surgical management (n = 11.8, SEQES = 13.8). Variability in reported outcome measures precluded meta-analysis. Conclusion: Qualitative synthesis of available literature suggests that acute sagittal band injuries can be successfully treated by splinting the injured digit in neutral or hyperextension. Patients with chronic injuries or those failing nonoperative management may benefit from surgical exploration. A lack of consistent outcome measures precluded comparison of surgical techniques.

Successful Non-operative Management of Metacarpophalangeal Collateral Ligament and Sagittal Band Rupture of the Long Finger: A Case Report

“…Posner & Ambrose later reported the injury in six professional athletes, and nearly all patients attained a full range of motion postoperatively [9]. The authors noted that accompanying extensor tendon subluxation resulted in more severe cases, a finding supported by a subsequent case series [10,11]. Our patient presented similarly with dynamic subluxation of the extensor tendon into the groove between the third and fourth digits with ulnar deviation of the long finger.…”

“…In contrast, type IV injuries typically require surgery [ 13 ]. Successful non-surgical management has been reported in the literature: Ritts et al utilized dorsal splinting in two patients with sagittal band ruptures, Catalano et al treated ten patients with a digital extension orthosis referred to as a sagittal band bridge, and Wu et al found nonoperative management to be a successful approach in injuries presenting within three weeks [ 11 , 14 , 15 ]. Our patient presented with a type IV rupture based on the presence of extensor tendon subluxation at his initial visit, three months following his injury.…”

Boxer's knuckle: Sonographic anatomy and assessment of sagittal band tears of the dorsal hood

“…Dislocation of extensor tendons involves displacement of the tendon into the groove between adjacent dorsal MC heads (valley between adjacent knuckles) and loss of contact with the dorsal aspect of the metacarpal head. 16,32 In When complete sagittal band tears occur to the second and fifth MCPJs, due to the presence of multiple tendons, ruptures of the connections between these tendons have been identified to also occur and one of the extensor tendons may displace to the radial side and one to the ulnar side of the MC head relative to midline. 19 The radial sagittal band is reported to be more susceptible to injury; this theory has been proposed as the radial sagittal band has been identified to be thinner and longer than the ulnar component on cadaveric studies.…”

“…Transient subluxation of the extensor tendon with flexion involves maintenance of contact of the tendon with the dorsal metacarpal condyle. Dislocation of extensor tendons involves displacement of the tendon into the groove between adjacent dorsal MC heads (valley between adjacent knuckles) and loss of contact with the dorsal aspect of the metacarpal head 16,32 . In complete sagittal band tears of the third and fourth MCPJs, ED tendon dislocation occurs when the tendon moves to the opposite side of the MC head relative to the side of the sagittal band tear.…”

Triggering, clicking, locking and crepitus of the finger: A comprehensive overview

“…EDC subluxation may present with a trauma history[ 20 ] in cases of sagittal band rupture, but may also have a spontaneous onset[ 20 ] in cases of sagittal band attrition[ 10 ]. The MCPJ will generally be swollen and tender dorsally with clicking (pseudo triggering)[ 10 ] noted during motion[ 11 ].…”