The oblique retinacular ligament of Landsmeer is a thin fascial band running from the flexor tendon sheath at the proximal phalanx obliquely to the dorsal extensor mechanism at the distal phalanx level (just proximal to the DIP joint). Its oblique course causes it to tighten with PIP joint extension and relax with PIP flexion, creating a mechanical coupling between PIP and DIP joint positions.
| Origin | Palmar side of the distal proximal phalanx and the adjacent fibrous flexor sheath (A2 and C1 region) |
|---|---|
| Insertion | Lateral border of the terminal extensor tendon over the middle phalanx, near the DIP joint |
Passes in front of the PIP joint axis and behind the DIP joint axis, so straightening the PIP joint tightens it and helps extend the DIP joint, linking the two joints
The Landsmeer ligament creates the coupled PIP-DIP motion: when the PIP is extended, the ligament tightens and extends the DIP passively; when the PIP is flexed, the DIP can flex freely. This mechanism is exploited in spiral oblique retinacular ligament reconstruction for swan-neck deformity, where a tendon graft along the Landsmeer path prevents PIP hyperextension while allowing PIP flexion. In Dupuytren disease, a lateral cord may incorporate the oblique retinacular ligament to produce combined PIP and DIP contracture.
Chronic boutonniere deformity with DIP hyperextension may develop secondary oblique retinacular ligament contracture that maintains DIP extension even after PIP is passively corrected; releasing the oblique retinacular ligament at the PIP level allows DIP flexion and is combined with central slip reconstruction and lateral band centralisation in late boutonniere repair.
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