Gamekeeper's Toe: A Case Series and Review of Surgically Treated Traumatic Hallux Varus Due to Lateral Collateral Ligament Injury.

BACKGROUND

Injuries to the lateral collateral ligament (LCL) of the first metatarsophalangeal (MTP) joint that are treated surgically are rare. We present 3 cases of traumatic LCL injury of the first MTP joint that were treated surgically for a Stener-like lesion preventing healing. Additionally, we present a review of previously published cases.

METHODS

Diagnosis was confirmed with magnetic resonance imaging and intraoperative stress tests, which demonstrated instability and LCL disruption with interposition of the adductor hallucis aponeurosis. All cases were managed operatively with suture anchor repair at the LCL origin or insertion. Patients were followed for 2-4 years postoperatively with outcomes assessed using the Foot and Ankle Outcome Score (FAOS) and the American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Score.

RESULTS

Three LCL repairs were performed in 2 patients, including 1 with bilateral injuries. At final follow-up, both patients had returned to high-level athletic activity. The mean FAOS was 97% and the mean AOFAS Hallux Score was 91.67%. Literature review identified 10 prior case reports with heterogeneous surgical techniques but consistently favorable outcomes.

CONCLUSION

This series presents a pattern of traumatic LCL injuries with a Stener-like lesion of the great toe that were treated with surgical repair and, to our knowledge, represents the first review of reported cases, offering a synthesis of diagnostic features, operative technique, and outcomes.

LEVEL OF EVIDENCE: Level IV, case series.