Ulnar Collateral Ligament (UCL) Repair

Abstract

Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. It is the result of repetitive stretching and abduction stresses of the ulnar collateral ligament and the adductor pollicis aponeurosis. Most UCL ruptures are distal. Pain at the phalangeal insertion of the UCL and joint swelling are the most common symptoms the patients with acute UCL rupture present with. To avoid the displacement of an associated undisplaced fracture, it is of utmost importance to the surgeon to obtain radiographs before applying any stress on the joint. Conservative nonoperative treatment with 4 weeks plaster immobilization of the fully extended joint is the treatment of choice for most partial or complete UCL ruptures provided that there is no interposition of the adductor pollicis aponeurosis between the extremities of the ligamentous fragments (Stener lesion), no displaced fracture, no spontaneous radiological palmar or lateral joint subluxation, no supination deformity, and no painful chronic laxity. If any of the abovementioned conditions is present, a surgical intervention is indicated.