A Comparison of Treatment Outcomes of Partial and Complete Radial Collateral Ligament Tears of the Index and Long finger.

BACKGROUND

The radial collateral ligament (RCL) is essential for metacarpophalangeal joint stability and plays a crucial part in pinch and grip strength of the index and long finger.

METHODS

This study compared treatment patterns and patient-reported outcomes for partial and complete RCL tears of the index and long finger. A database from six U.S. urban hospitals was reviewed for RCL injuries to the index or long finger between January 2004 and March 2022. Eligible patients were asked to complete the QuickDASH questionnaire. The injury-to-study inclusion interval showed a median of 5.7 years. Patients were classified according to initially intended treatment and definitive treatment. Nonoperative treatment failure was defined as conversion to surgery after initially intended nonoperative treatment.

RESULTS

Seventy-three patients with RCL injuries (46 index, 27 long finger) were included. Twenty-five of 46 (54%) index and eleven of 27 (41%) long finger injuries underwent surgical treatment. Of 66 patients eligible for QuickDASH assessment, 58% completed the questionnaire. Complete RCL tears treated nonoperatively had the highest median QuickDASH score (14, n = 5), and partial RCL tears treated nonoperatively had the lowest median QuickDASH score (0, n = 14). The ligament ruptured from the proximal metacarpal attachment in 33/44 (75%) of all cases. Conversion to surgery after initially intended nonoperative treatment occurred in six out of 12 (50%) complete RCL tears of the index finger and eight out of 15 (53%) of the long finger.

CONCLUSION

Complete tears treated nonoperatively had higher median QuickDASH scores than complete RCL tears treated surgically, while partial tears treated nonoperatively had the lowest scores overall. Conversion to surgery after initially intended nonoperative treatment was ≥ 50% for complete RCL tears. Our descriptive findings are hypothesis-generating and suggest surgical treatment for complete RCL may be considered for shared decision-making in symptomatic patients with high functional demand, pending confirmation in larger, prospective studies.

LEVEL OF EVIDENCE: Therapeutic III.