Metacarpophalangeal ligamentoplasty in typical cleft hand

The surgical handling of central cleft hands may involve various procedures to restore acceptable function. Stabilization of the merged cleft is usually achieved through reconstruction of the intermetacarpal ligament. However, no attention has been paid to the agenesis of the metacarpophalangeal collateral ligaments adjacent to the cleft, which is responsible for an excessive laxity of the joint in the frontal plane. We propose an autologous ligamentoplasty aimed at stabilizing the metacarpophalangeal joint while taking into account the specificities of the immature skeleton. A tendon graft is harvested and passed in a figure-of-eight manner around the base of the proximal phalanx and the corresponding metacarpal neck. No transosseous tunnels or bone anchors are used, as these might result in growth plate injury. As the graft does not have any fixed bony attachment, it is free to glide throughout growth, therefore avoiding the occurrence of progressive overtightening.