Acute Ulnar Collateral Ligament Injury Research Articles

The management of acute complete ruptures of the ulnar collateral ligament of the thumb.

Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK. We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively. A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm 'endpoint' to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30° of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial. The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject.

New Diagnostic-Based Systematic Classification for Skier's Thumb Injuries: A Revision That is Needed

Abstract Background Acute injuries to the ulnar collateral ligament (UCL) of the first metacarpophalangeal joint (MCPj), commonly referred to as Skier’s thumb injuries, can be further categorized into different types based on bone lesions and joint instability. However, none of the existing classifications encompasses all types and combinations of injuries. A unified classification system that provides direct treatment recommendations for each type is required, particularly for cases with no clear indications. Aims To develop a new classification system for acute UCL injuries of the first MCPj that comprehensively defines all possible combinations and types of injuries and facilitates treatment decision-making for each specific type in daily clinical practice. Methods The retrospective study included patients with acute UCL lesions who underwent conservative or operative treatment at our clinic between 2018 and 2023. This classification addresses ligamentous or osseous lesions, fracture fragment size and dislocation, ligament configuration (e.g. Stener lesions), and joint stability. Correlated radiography, ultrasonography, MRI, and intraoperative findings were used to define all combinations and variants of skier`s thumb injuries. Pre-therapeutic joint stability was characterized according to the criteria established in the literature. Dislocation criteria for bone lesions were defined in a preliminary observer trial. The classification was applied by three hand surgeons with different training levels. Treatment applied and a 3-months follow-up was documented. Results In 213 patients with acute UCL tears, the new classification was consistently applied, and the treatment derived was largely aligned with the recommendations in the literature for both absolute and relative indications for splint or operative therapy. The vast majority of the patients were stable after 3 months. Conclusion This new classification is the first to combine the clinical and radiological aspects of skier`s thumb injuries into one classification and encompasses all variants. It is comprehensive, can be easily applied retrospectively, and provides clear treatment recommendations in most cases.

Clinical and functional outcomes of surgical treatment of grade III ulnar collateral ligament injuries of thumb metacarpophalangeal joint

ObjectivesThe aim of this study was to compare the clinical and functional outcomes of three surgical techniques (subperiosteal suture, bone anchor and direct repair) for the management of severe acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with a minimum of 1 year follow-up. Material and methodsBetween 2015 and 2020, 230 collateral ligament injuries required surgical treatment in our department. After the inclusion and exclusion criteria were applied, 100 were included in the study. The Glickel score and functional scores such as QuickDASH and PRWE were assessed. Time to return to work and to sport was quantified. ResultsUlnar collateral ligament injuries affected men who were statistically younger than women (41.8 years old vs 48.3). Subperiosteal suture was the preferred technique (81%), then bone anchor reattachment (12%) and direct repair (7%). All three techniques produced excellent stability (91–100%). Better range of motion was reported in the subperiosteal group, but better strength was found in the bone anchor group. Subperiosteal suture had 89% excellent and good results, while there was 83% in the bone anchor group and 71% in the direct repair group. Mean time to return to work was 2 months in the bone anchor group versus 3 months in the subperiosteal group. Mean QuickDASH was 8.7/100 and mean PRWE was 7.1/100. ConclusionThis is the biggest case series to date on surgical treatment of severe ulnar collateral ligament injuries of the thumb metacarpophalangeal joint. The subperiosteal technique is simpler and less expensive. While the results are not often described in the literature, it produces comparable clinical and functional outcomes to bone anchor reattachment with a minimum follow-up of 1 year.

Long-term outcomes following surgical repair of acute injuries of the thumb metacarpophalangeal joint ulnar collateral ligament

The primary aim of this study was to describe the long-term patient reported outcomes following surgical repair of acute injuries to the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL). The secondary aims were to describe the long-term health related quality of life, patient satisfaction and complication rate. From a single surgeon series, 30 patients were identified over an 11 year period (February 2000–February 2011). QuickDASH, EQ-5D-5L, and satisfaction scores were collected from 22 patients (73%) at mean 183 month follow up. The median QuickDASH score was 2.27. Median EQ-5D-5L was 0.88. Satisfaction rate was 82%, Net Promotor Score was 90. Significantly worse QuickDASH scores were seen in patients that developed MCP joint arthrosis or had had subsequent ipsilateral hand injuries (median 39.7 vs 2.27; p = 0.002). All the patients employed at the time of surgery returned to work without long-term adaptations. Surgical repair of acute UCL injury generally provides an excellent long-term functional outcome and satisfaction rate. Complications are rare but where MCP joint arthrosis develops functional outcomes can be significantly worse.

Elbow Ulnar Collateral Ligament Shoelace Repair with Internal Bracing for Treating Throwing Athletes Who Have Ulnar Collateral Ligament Instability

This Technical Note aimed to present a surgical technique of ulnar collateral ligament (UCL) shoelace repair using suture anchors and double suture tapes in combination with internal bracing to correct UCL instability along with epiphyseal avulsion of the medial epicondyle in throwing athletes Skeletally immature throwing athletes playing baseball and softball are at a risk of sustaining medial epicondyle epiphyseal separation that can result in UCL instability, predisposing to elbow UCL disruption later. There are several surgical techniques that can restore elbow UCL function and stability. In cases where large fragments of the medial epicondyle are present in skeletally immature athletes, the residual bony fragment and the shortened, chronically injured UCL make surgical treatment quite challenging. Recent studies have shown that UCL repair with internal bracing can effectively treat acute UCL injury. However, this procedure is not ideal for restoring large disruption of the UCL such as fragmentation. Here, we present a surgical technique of UCL shoelace repair using suture anchors with double suture tapes in combination with internal bracing for correcting UCL instability concurrent with epiphyseal fragmentation of medial epicondyle in throwing athletes.

The effects of rehabilitation on the outcomes of surgically treated acute and chronic thumb metacarpophalangeal ulnar collateral ligament ruptures

The aim of this study was to compare the outcome of patients who received rehabilitation to those who did not receive it after surgical treatment of acute and chronic tears of the ulnar collateral ligament (UCL) of the thumb. Forty-two patients with an acute UCL injury repaired with two soft mini-anchors to bone insertion sites, and 40 patients with a chronic UCL injury reconstructed with autografts were involved in this study. The patients were divided two subgroups depending on rehabilitation. Patient characteristics were not significantly different between the two groups and subgroups. Range of motion, grip strength and pinch strength were evaluated. There was no significant change in terms of grip and pinch strength in patients with acute UCL injury who received rehabilitation after surgical treatment. However, significantly better results were achieved in flexion, extension, ulnar and radial deviation. There was no significant change in pinch strength in patients with chronic UCL reconstructions, but significantly better results were achieved in grip strength, flexion, extension, ulnar and radial deviation. A rigid MCP splint in patients with acute and chronic UCL tears is effective in preventing early ligament insufficiency.

Biomechanical Evaluation of a Modified Internal Brace Construct for the Treatment of Ulnar Collateral Ligament Injuries.

Background:Ulnar collateral ligament (UCL) repair augmented with the “internal brace” construct for the management of acute UCL injuries has recently garnered increasing interest from the sports medicine community. One concern with this technique is excessive bone loss at the sublime tubercle, should revision UCL reconstruction be required. In an effort to preserve the bony architecture of the sublime tubercle, an alternative internal brace construct is proposed and biomechanically compared with the gold standard UCL reconstruction.Hypothesis:The internal brace repair construct will restore valgus laxity and rotation to its native state and demonstrate comparable load-to-failure characteristics with the 3-strand reconstruction technique.Study Design:Controlled laboratory study.Methods:For this study, 8 matched pairs of fresh-frozen cadaveric elbows were randomized to undergo either UCL reconstruction with the 3-ply docking technique or UCL repair with a novel internal brace construct focused on augmenting the posterior band of the anterior bundle of the ligament (modified repair-IB technique). Valgus laxity and rotation measurements were quantified through use of a MicroScribe 3DLX digitizer at various flexion angles of the native ligament, transected ligament, and repaired or reconstructed ligament. Laxity testing was performed from maximum extension to 120° of flexion. Each specimen was then loaded to failure, and the method of failure was recorded.Results:Valgus laxity was restored to the intact state at all degrees of elbow flexion with the modified repair-IB technique, and rotation was restored to the intact state at both full extension and 30°. In the reconstruction group, valgus laxity was not restored to the intact state at either full extension or 30° of flexion (P < .001 and P = .004, respectively). Laxity was restored at 60° of flexion, but the elbow was overconstrained at 90° and 120° of flexion (P = .027 and P = .003, respectively). In load-to-failure testing, the reconstruction group demonstrated significantly greater yield torque (19.1 vs 9.0 N·m; P < .005), yield angle (10.2° vs 5.4°; P = .007), and ultimate torque (23.9 vs 17.6 N·m; P = .039).Conclusion:UCL repair with posterior band internal bracing was able to restore valgus laxity and rotation to the native state. The construct exhibited lower load-to-failure characteristics when compared with the reconstruction technique.Clinical Relevance:In selected patients with acute, avulsion-type UCL injuries, ligament repair with posterior band internal bracing is a viable alternative surgical option that, by preserving bone at the sublime tubercle, may decrease the complexity of future revision procedures.

Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb

This study sought to demonstrate that successful outcomes can be achieved with the new technique presented here for chronic ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal (MCP) joint, as well as with K-wire pinning for acute UCL injury. We followed 19 patients who suffered an UCL rupture (mean follow-up: 14.26±4.65 months) and 32 patients who presented with UCL avulsion fracture (mean follow-up: 16.81±7.54 months). We used a free tendon graft for UCL reconstruction in the UCL rupture group. Both ends of the graft were stabilized with bioabsorbable suture anchors, which were used as biotenodesis interference screws. Closed reduction and K-wire fixation was used in UCL avulsion fracture group. There were no statistically significant differences between operated and contralateral healthy thumb MCP joint in both groups in the grip strength, tip pinch strength, flexion, extension, ulnar deviation, and radial deviation movements at final follow-up. Grip strength, tip pinch strength, ulnar deviation and radial deviation were significantly better in the avulsion group than the rupture group. All patients regained full stability at the MCP joint in avulsion group; 16 patients regained full stability and 3 patients presented with mild laxity (less than 10° laxity) in rupture group. Glickel grading scale used as a functional score was excellent for 30 patients and good for 2 patients in avulsion group; it was excellent for 17 patients and good for 2 patients in rupture group. Our study shows that closed reduction and percutaneous K-wire fixation of acute displaced large UCL avulsion fracture is a simple technique and achieves adequate stability of UCL. For UCL rupture, free tendon reconstruction with bioabsorbable suture anchors provides adequate stability and stable fixation within the tunnels.

Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with Mitek microsuture anchor

Objective To evaluate the effectiveness of Mitek microsuture anchors in the reconstruction of acute ulnar collateral ligament(UCL) injuries of the thumb metacarpophalangeal joint. Methods From July 2004 to May 2009, 11 patients with acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint were treated using the Mitek microsuture anchors for one-stage repair. The Mitek microsuture was anchored in the first metacarpal head or the lateral side of proximal phalanx base of the thumb where the ulnar collateral ligament had avulsed. The suture end was sewn through the collateral ligament to reconstruct its attachment. Results Postoperatively the patients were follow-up for 6 months to 4 years, with an average of 2.4 years. According to Saetta functional assessment standard, the results were graded as excellent in 7 cases, good in 3 cases, and fair in 1 case. The overall excellent and good rate was 90.9%. X-rays showed no loosening or displacement of the anchors. Conclusion Suture anchor technique can be recommended as a simple and effective method for repairing ulnar collateral ligament injuries of the thumb metacarpophalangeal joint. Key words: Thumb; Collateral ligaments; Metacarpophalangeal joint; Suture anchors

Repair of Acute Ulnar Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint: A Retrospective Comparison of Pull-Out Sutures and Bone Anchor Techniques

The use of intraosseous suture anchors in the treatment of ruptures of the ulnar collateral ligament of the thumb metacarpophalangeal joint has previously been described. However, no direct comparisons exist of ulnar collateral ligament repair with bone anchor versus repair with a pull-out button and immobilization. Two cohorts of patients with complete rupture of the ulnar collateral ligament of the thumb metacarpophalangeal joint were compared. Thirty patients in each cohort underwent repair of the ulnar collateral ligament with either an intraosseous suture anchor followed by early mobilization or a pull-out suture tied over a button with cast immobilization. Average follow-up was 29 months. At follow-up, range of motion at the metacarpophalangeal and interphalangeal joints for the anchor group averaged 97 percent of that of the contralateral side compared with 86 percent and 87 percent, respectively, for the button group. For the anchor group, pinch strength averaged 101 percent that of the contralateral side compared with 95 percent for the button group. No significant difference was noted between the groups for grip strength. Average tourniquet time for the anchor group was 28 minutes compared with 43 minutes for the button group. Soft-tissue complications were present in 27 percent of patients (eight of 30) in the pull-out button group compared with 7 percent (two of 30) in the anchor group. Cost analysis demonstrates an approximately $140-per-patient savings when using the suture anchor. Both repair methods are safe and effective for treating thumb ulnar collateral ligament injuries. Suture anchors allow for an accelerated rehabilitation protocol, which may account for the improved range of motion and pinch strength at follow-up.

Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with an intraosseous suture anchor

Thirty-six consecutive patients with 37 complete tears of the ulnar collateral ligament of the thumb metacarpophalangeal (MP) joint were treated with primary repair using a miniature intraosseous suture anchor. Thirty patients were evaluated by clinical examination or by questionnaire at an average of 11 months after repair. Loss of interphalangeal joint motion averaged 15 degrees on the involved side versus the other side, while loss of MP joint motion averaged 10 degrees. There was no significant difference on stress testing measurements between repaired and nonrepaired thumbs. There were no instances of nerve injury, infection, device failure, or reoperation. The authors concluded that this is a safe and effective method for repair of complete tears of the ulnar collateral ligament of the thumb MP joint.

Acute Ulnar Collateral Ligament Injury in a Baseball Pitcher.

A group of experts discussed a case from the American Sports Medicine Institute in Birmingham, Alabama. This case conference is part of a series featuring a variety of sports medicine topics.