Sagittal band rupture and reconstruction

Patient 1: Conservative treatment

Video demonstrates extensor snapping without locking, pain or inflammation. This has been stable for years and does not require treatment:

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.
  1. Exposure
  2. Demonstration of the pathologic anatomy
  3. 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.
  4. 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.
  5. The tendon graft is passed deep to the ulnar intermetacarpal ligament and then sutured back to the central tendon.
  6. In this case, the tendon graft was also woven through the stump of the tendinous juncture for anatomic reconstruction.
  7. Surgeon's discretion: tendon repair secured with a looped 3-0 Supramid to minimize knot prominence.
  8. Redundant tendon is excised. Wound closed with 5-0 intradermal Monocryl.

Patient 3: Before and After

Video demonstrates preop instability, result at 3 weeks (without ring) and then 3 months postop (with ring):

Click here for additional images of sagittal band rupture and reconstruction.