Anatomic Repair and Reconstruction of Radial Sagittal Band Ruptures

Two cases of traumatic sagittal band rupture causing extensor tendon subluxation are reported. A case of subacute rupture is repaired and a new surgical technique for reconstruction of a chronic rupture is described. Extensor tendon subluxation at the metacarpophalangeal joint is a rare occurrence in patients not affected by rheumatoid arthritis. The majority of cases involve the disruption of the radial sagittal band with consequent ulnar subluxation of the extensor tendon. The technique of sagittal band reconstruction described involves harvesting a distally based ulnar-sided strip of the extensor digitorum communis tendon, passing it transversely through the radial component of the tendon, and then looping it deep to the deep transverse metacarpal ligament. From here the tendon is then sutured back onto the central tendon, creating a delta-shaped graft. This technique reconstructs the normal anatomy of the sagittal band and has been found to eliminate the subluxation of the tendon and its associated pain.