Thumb metacarpophalangeal joint ulnar collateral ligament reconstruction using a tendon graft

Chronic instability of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb can cause significant functional disability due to pain and weakness of pinch and grasp. In the absence of adequate ligament to repair, stability of the joint can be restored by reconstruction using a free tendon graft. The technique described here routes the tendon graft through two holes in the proximal phalangeal base and one hole in the metacarpal neck in a triangular configuration, which recapitulates the normal anatomy of the ulnar collateral ligament. The results of reconstruction are good. Stability and strength are restored without sacrificing significant range of motion and with minimal donor site morbidity.