Boxer's knuckle in the professional athlete

Injuries to the extensor mechanisms of the fingers can be career-ending in professional athletes if not treated appropriately. We identified 8 profess ional athletes who underwent 11 direct metacarpophalangeal joint extensor m echanism repairs including centralization of the extensor tendon and sagitt al band repair between 1989 and 1994. Success of the operative procedure wa s determined by the athlete's attainment of full range of motion, return to professional sports, and no need for additional surgical intervention. The metacarpophalangeal joints of the long and little fingers were most common ly involved. The position of the extensor mechanism disruption and the dire ction of the tendon subluxation varied. Capsular tears were identified in s even joints and none were repaired. At follow-up, each athlete had regained full range of motion and each had returned to professional sport an averag e of 5 months postoperatively. No patient required additional surgery. In t his series, the principal lesion in metacarpophalangeal joint injury was ex tensor mechanism disruption with a predictable sagittal band tear and eithe r a radial or ulnar subluxation of the central tendon. We recommend central ization of the extensor tendon and sagittal band repair without capsular re pair as a treatment of choice for this injury, particularly in the athlete.