The value of radial collateral ligament reconstruction and abductor digiti minimi release in metacarpophalangeal joint arthroplasty

Rheumatoid arthritis is a chronic, progressive disease characterized by destructive synovitis commonly involving the hand. Ulnar drift deformity has been reported in up to 30% of these patients. Metacarpophalangeal (MCP) joint arthroplasty with soft-tissue reconstruction was described to correct this deformity, but recurrence is a common problem. This is a retrospective study of 18 patients who underwent 96 primary index to little finger MCP joint arthroplasties in Montreal General Hospital. Patients were divided into 2 groups. In group I, 60 MCP joints in 15 hands had silastic arthroplasty with radial collateral ligament reconstruction and abductor digiti minimi release. In group II, 36 MCP joints in 9 hands had silastic arthroplasty without soft-tissue reconstruction. All patients had the same postoperative rehabilitation, with a follow-up mean time of 63 months. Postoperative clinical and radiologic comparison was performed. Group I was found to have more severe wrist disease. No significant difference was seen between the 2 groups for ulnar drift (D2, P < 0.79; D3, P < 0.11; D4, P < 0.49; D5, P < 0.31), active range of motion, power grip, incidence of MCP subluxation, or functional ability. MCP arthroplasty with radial collateral ligament reconstruction and abductor digiti minimi release may recreate a short-term balance of forces around the MCP joint but does not prevent late postoperative deformity. This is a preliminary study with a small sample size but supported previous reports on MCP arthroplasty with soft-tissue reconstruction.