Anatomic Reconstruction of Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Using an Interference Screw Docking Technique

Abstract

Complete rupture of the ulnar collateral ligament injury of the thumb metacarpophalangeal (MCP) joint can be a debilitating injury resulting in decreased grip and pinch strength. The spectrum of injury to this ligament varies from simple strain to complete rupture of both proper and accessory ligaments. Generally, this is a result of an abduction force transmitted across the thumb MCP joint.Physical examination assists in identification of these injuries and the extent of ligamentous injury. Ecchymoses and pain over the ligament are usually present in the acute injury. Chronic injuries may not be painful. A palpable mass may be present. The valgus stress test across this joint in 30 degrees of flexion provides information on the competency of the proper ligaments, whereas valgus stress in extension assesses the accessory collateral ligaments. This stress test is useful in the acute or chronic setting.Stabilization of the thumb MCP joint in chronic injuries can require reconstruction. We describe an anatomic reconstruction using a tendon graft and a bioabsorbable interference screw.