The junctura lasso: Correction of extensor tendon displacement

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 66; no. 11; pp. 1610 - 1612
• Main Authors: Yong, Chin Chean, Connolly, Cara M, Erdmann, Matt
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.11.2013
• Subjects: Extensor digitorum communis; Humans; Male; Metacarpophalangeal joint; Metacarpophalangeal Joint - physiopathology; Metacarpophalangeal Joint - surgery; Middle Aged; Plastic Surgery; Secondary Prevention; Surgical technique; Tendon dislocation; Tendon Injuries - surgery; Tendon injury; Metacarpophalangeal joint; Tendon injury; Tendon dislocation; Surgical technique; Extensor digitorum communis
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2013.01.032

Summary Recurrent volar displacement of the extensor digitorum communis tendon (EDC) at the metacarpophalangeal joint (MCPJ) more commonly occurs post-trauma or in the rheumatoid hand. This disabling condition of the hand results in painful swelling of the MCPJ, associated with “locking” of the extensor tendon. We report a simple surgical technique used to successfully ‘secure’ the EDC from recurrent displacement. This was performed for a 59-year-old man who developed the condition in his ring finger, following Vth ray amputation for severe Dupuytren's disease. First, the EDC over the IIIrd and IVth MCPJ are exposed using a longitudinal incision. The junctura tendinum between the EDC tendons was next extended proximally by 2 cm on the radial side of the IVth EDC and then divided to create a distally based junctura slip. Next, a ‘lasso’ was created by passing the slip beneath the IVth EDC tendon and then securing it onto itself with a 5/0 Ethibond suture (Ethicon Inc.). This reconstruction was then tested in all ranges of MCPJ flexion, successfully preventing volar displacement of the extensor tendon. The ‘junctura lasso’ provided a satisfactory solution for the patient, who, over the next four years; for the duration of his follow-up, suffered no further displacement of the extensor tendon.