Combined Open Sagittal Hood Repair and Metacarpophalangeal Joint Arthroscopy: A Comprehensive Approach to Complex Knuckle Injuries.

Isolated management of metacarpophalangeal (MCP) joint injuries or sagittal band disruptions often leads to incomplete symptom resolution and suboptimal functional outcomes, particularly in complex trauma. We present a combined surgical technique integrating MCP joint arthroscopy with open sagittal hood repair for traumatic extensor mechanism instability and intra-articular pathology. This paper describes a stepwise approach to address both intra-articular and soft tissue components of MCP joint injuries. Arthroscopy facilitates direct visualization, synovectomy, debridement, and capsular shrinkage, while open sagittal band repair allows for tendon centralization, repair of a hood rupture, and occasional definitive realignment. This dual approach provides a comprehensive treatment option, ensuring the stabilization of both the joint capsule and the extensor mechanism. An illustrative case demonstrates restored tendon alignment and joint stability with no intraoperative complications, highlighting how this combined technique enhances diagnostic precision and therapeutic outcomes in complex MCP joint injuries.