Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon or fascial graft (includes obtaining graft)
CPT4 code
Name of the Procedure:
Reconstruction of the Collateral Ligament, Metacarpophalangeal Joint, Single; with Tendon or Fascial Graft (includes obtaining graft)
Summary
This surgical procedure involves repairing and reconstructing a damaged collateral ligament in one of the metacarpophalangeal (MCP) joints (knuckle joints). The surgery uses a graft taken from a tendon or fascia (connective tissue) to replace or reinforce the damaged ligament.
Purpose
This procedure addresses the instability, pain, or dysfunction caused by a torn or severely damaged collateral ligament in the MCP joint. The goal is to restore joint stability, improve hand function, and alleviate pain.
Indications
- Chronic instability of the MCP joint
- Ligament tears or ruptures that haven't healed with conservative treatment
- Pain and dysfunction that interfere with daily activities despite non-surgical interventions
- High-demand hand use that warrants surgical repair for optimal function
Preparation
- Patients may need to fast for a specific period before the surgery.
- Adjustments to current medications, especially blood thinners, may be necessary.
- Pre-operative imaging (e.g., MRI or X-ray) to assess the extent of the injury.
- Pre-surgery consultation to discuss the procedure and obtain consent.
Procedure Description
- The patient is given regional or general anesthesia.
- An incision is made near the affected MCP joint.
- The damaged collateral ligament is identified and prepared for reconstruction.
- A tendon or fascial graft is harvested, usually from the patient's wrist or forearm.
- The graft is carefully positioned and secured to reconstruct the torn ligament.
The incision is closed with sutures, and a sterile dressing is applied.
Tools and equipment include surgical instruments, sutures, and graft-harvesting equipment.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
This surgery is performed in a hospital or an outpatient surgical center.
Personnel
- Orthopedic or hand surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding or hematoma
- Graft failure or re-tear of the ligament
- Stiffness or decreased range of motion
- Nerve injury resulting in numbness or tingling
- Anesthetic complications
Benefits
- Increased joint stability
- Improved function and range of motion in the hand
- Reduction in pain
- Ability to return to normal daily activities and, in some cases, sports or other demanding hand activities
Recovery
- Post-operative immobilization of the hand in a splint or cast for several weeks.
- Pain management with medications.
- Gradual physical therapy to restore movement and strength.
- Full recovery and return to activities may take several months.
- Regular follow-up appointments to monitor progress.
Alternatives
- Non-surgical treatments such as bracing, physical therapy, and medications
- Corticosteroid injections for pain and inflammation management
- Pros: Non-invasive, fewer risks, quicker initial recovery
- Cons: May not restore full function or stability, symptoms might persist or recur
Patient Experience
During the procedure, patients will be under anesthesia and will not feel pain. Post-procedure, they might experience discomfort, swelling, and bruising, which can be managed with pain relief measures. Initial immobilization followed by gradual rehabilitation helps in recovery.