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Landsmeer Oblique Retinacular Ligament

ligamentum retinaculare obliquum Landsmeer

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.

Region: Hand & Wrist

Clinical Relevance

Clinical Notes

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.

Pathology

Common Injuries & Conditions

Oblique Retinacular Ligament Tightness in Boutonniere Repair

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.