Patient 2: Sagittal band reconstuction in 90 seconds
The steps in this video demonstrate Watson's technique: a distally based slip of the central extensor tendon is passed around the transverse intermetacarpal ligament and sutured back to itself. This provides a more reliable technique than simple repair or imbrication.
- Demonstration of the pathologic anatomy
- Tendon harvest. Watson's description uses the central third of the tendon, which avoids the need to repair tendinous junctures - but either third may be used. In this case, the radial third was used, disinserting and then reconstructing the tendinous juncture.
- The tendon graft is woven back through the remaining central tendon in a locked loop to prevent longitudinal tendon separation and migration of the force vector of the repair.
- The tendon graft is passed deep to the ulnar intermetacarpal ligament and then sutured back to the central tendon.
- In this case, the tendon graft was also woven through the stump of the tendinous juncture for anatomic reconstruction.
- Surgeon's discretion: tendon repair secured with a looped 3-0 Supramid to minimize knot prominence.
- Redundant tendon is excised. Wound closed with 5-0 intradermal Monocryl.