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Collateral ligament repair or reconstruction (finger PIP and MCP joints)
This surgery repairs or reconstructs a torn collateral ligament at the side of a finger’s PIP or MCP joint, restoring stability for pinch and grip.
At a glance
Anaesthetic
General anaesthetic, sometimes combined with a regional nerve block
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
One to two weeks after surgery
Driving
Not until out of your splint and you have adequate finger strength and control
Post Operative Hand Therapy
Required for splinting and rehabilitation after splint removal
Splinting
Yes - a protective splint is usually worn for 6-8 weeks
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed for the first few days
Return to repetitive & heavy loading
Usually 8 weeks before resuming sport or heavy activities
Repair or reconstruction of a collateral ligament of the finger
This surgery repairs or reconstructs a torn collateral ligament at the side of the PIP or MCP joint of a finger. An incision is made over the injured side of the joint, the torn ligament ends are identified, and repaired directly with sutures or suture anchors. If the ligament tissue is deficient — for example in a chronic or neglected injury — it is reconstructed using a tendon graft instead. A displaced bony avulsion fragment, if present, may be fixed with a suture or a small screw or wire at the same time.
Who is this procedure for?
- A complete collateral ligament tear causing instability of the finger joint, confirmed on examination and imaging
- A displaced bony avulsion fragment from the ligament's attachment
- Chronic or neglected instability that is affecting grip, pinch or sporting activity
- Not usually needed for a partial tear with a stable joint, which can often be treated with splinting alone
What does the surgery involve?
Surgery involves an incision over the injured side of the affected joint. The torn ligament is identified and repaired with fine sutures or suture anchors, or reconstructed with a tendon graft if the ligament tissue cannot be directly repaired. A displaced bony avulsion fragment is fixed if present. The wound is closed and a protective splint is applied.
Alternatives to surgery
Surgery is one option for a collateral ligament injury of the finger. Depending on your situation, the alternatives may include:
- Buddy taping or splinting alone: appropriate for a partial tear with a stable joint on examination
- Direct repair versus reconstruction: depends on the quality of the remaining ligament tissue and whether the injury is acute or longstanding
What happens if left untreated: an untreated complete tear can lead to chronic joint instability, weak pinch or grip, and an increased risk of early joint arthritis.
Dr Tomlinson will discuss which options suit your specific injury at your consultation. Non surgical treatment is not recommended when there has been a complete tear with an unstable joint.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves. If your work is desk-based, you may return within a week or two with your hand splinted. If your job is manual or involves repetitive use of the hand, you will usually need longer, guided by your hand therapist.
When will I be able to drive again?
Not until you are out of your splint and have enough strength and control of the finger to drive safely and comfortably.
When can I do a full day of administrative or desk work?
Often from 1-2 weeks after surgery, particularly with some workplace modifications, provided the splinted hand is not required for typing or heavy use.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include voice-to-text software, a modified keyboard or mouse set up for one-handed use, or reassigning tasks that need two hands.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during a general anaesthetic. In line with current ANZCA guidance, if you’re having a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
A protective splint is usually worn for around 4 to 6 weeks, depending on whether the ligament was repaired or reconstructed and whether a bony fragment was fixed.
Will I need to see a hand therapist afterwards?
Yes. You will see a hand therapist for splinting, and for a graduated exercise program once your splint is reduced or removed.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is enough. Stronger pain relief can be prescribed for the first few days if needed.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Stiffness of the joint, which is common after any finger joint injury or surgery and improves with hand therapy
- Residual instability if the repair or reconstruction stretches or does not fully hold
- Altered sensation if a small nerve branch near the joint is irritated or injured
- Failure of a tendon graft, where used, to provide full stability
- The need for further surgery in a minority of cases
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and swelling
First week
Keep the splint and dressing dry and intact. You may use your hand gently for light tasks outside the splint as directed
Second week
The finger remains in a splint to protect the repair while early healing continues
6 weeks
You can usually begin weaning your splint and commence a graduated strengthening program with your hand therapist
3 months
The scar firmness will start to resolve after 3 months, and grip and pinch strength continue to improve
Long term
The splint is typically removed around 4 to 6 weeks, followed by progressive return to full activity and sport over the following weeks under your hand therapist's guidance
Want to know more about collateral ligament repair or reconstruction?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.