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Current diagnostic criteria and therapeutic guidelines for injuries to the collateral ligaments of the proximal interphalangeal (PIP) joint are imprecise and vague. Laxity determinations, failure analysis, radiographic stress testing, and microscopic dissections were performed on 112 PIP joints. The lateral collateral ligament (LCL) is the primary restraint to varus and valgus angulation of the PIP joint. Its palmar fibers are tight in joint extension and provide the first line of resistance to lateral angulation. Failure of the LCL almost always occurs proximally in a sequential fashion that begins with the palmar fibers and progresses to the more dorsal bundles. Proximal LCL disruption is followed by separation of the accessory collateral-LCL junction and finally by failure of the distal palmar plate. Midsubstance tears of the LCL are rare. If the lateral stress test shows more than 20° of varus or valgus angulation, the LCL can be presumed to be completely disrupted. Angulation of less than 20° is associated with a 53% chance of partial LCL failure and a 47% chance of complete disruption, but the proper position of the LCL will be maintained by the overlying connective tissues. A clinical investigation will be necessary to define the criteria for surgical intervention.
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Accepted: January 9, 1986
Received: July 8, 1985
+Supported by grants from the Orthopaedic Research and Education Foundation and the Musculoskeletal Disease Program of the NIADDKD.
© 1986 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.