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A lazy –S incision is placed over the ulnar aspect of the first MCP joint. The capsule is opened exposing the first metacarpal head and base of the proximal phalanx. Guidewires are placed at these anatomic locations and unicortically overdrilled with a 3 or 3.5 mm drill bit. A slip of PL tendon graft is harvested. Each end of the graft is pulled inside each drill hole and securely fixed with 3 x 8 Tenodesis Screws ensuring proper tensioning.This construct allows for direct tendon-to-bone healing, without hardware prominence. (https://www.arthrex.com)

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