Utilizing Bone Anchors in Sagittal Band Reconstruction with Extensor Tendon Centralization: A Case Series and Literature Review

Abstract

Objective: There are multiple complex tissue reconstruction techniques described for repair of sagittal band rupture in patients with subluxation of extensor tendons over the metacarpophalangeal joint. In our surgeon group, we have been performing a technically simpler repair using bone anchors with good success for several years. Our objectives are to report these findings and review any previously reported use of the technique. Methods: We reviewed all operative reports in a group of sixteen hand surgeons coding for centralization of extensor tendon from 2011 to 2022. Within those cases we selected out each case that utilized bone anchors for sagittal band repair. We then reviewed records for evidence of recurrent symptoms, subluxation, pain, or re-operation. We also noted the duration of follow up. Results: The procedure was performed by four of the sixteen surgeons. Twelve patients were identified by searching for the centralization of extensor tendon code and reviewing operative reports. We identified two additional patients who returned to our clinic for other reasons, one performed as early as 1997. We suspect several more were missed due to not searching prior to 2011 or different coding. These fourteen patients totaled 31 fingers all together. Of those, etiologies included six cases (21 fingers) of rheumatoid arthritis or other inflammatory arthritis, eight cases (10 fingers) of trauma, spontaneous rupture, or osteoarthritis. The patients with inflammatory arthritis tended to have multiple finger involvement. Follow up ranged from 6 weeks to 25 years, an average of 30 weeks (excluding the 1997 case) or 65 weeks including it. We found one case of recurrence in the first 90 days requiring reoperation. This was thought to be due to a technical error. All patients reported postoperatively no locking or clicking, reduction in pain, and improved range of motion. We excluded three patients (10 fingers) that were repaired similarly with suture tunnels through bone rather than bone anchors. These had similar postoperative results. We were only able to identify three case reports of similar repairs using bone anchors performed in the literature. These each reported good results at 1 year. Conclusion: Repair of sagittal band rupture and extensor tendon subluxation at the metacarpophalangeal joint with suture anchors is a simple, and effective technique. Although we are not the first to publish such a technique, we did identify several cases that were performed prior to the identified publications. Our data is the largest case series reported to date, and is consistent with the previously reported excellent results. Corresponding Author: Matthew Shaheen, MD, 627 Butternut Ave., Royal Oak, MI 48073