Rupture Of Ulnar Collateral Ligament Research Articles

Clinical outcomes after primary repair for thumb ulnar collateral ligament ruptures: a systematic review and meta-analysis.

There is no consensus on the best surgical technique for treating thumb ulnar collateral ligament (UCL) ruptures. This systematic review and meta-analysis investigates which primary repair technique and postoperative immobilization protocol result in the best clinical outcomes. A literature search was conducted in Embase, Medline ALL Ovid, Web of Science Core Selection and Cochrane Central Register of Controlled Trials. Pain, stability, tip pinch strength, key pinch strength, grip strength, return to work and metacarpophalangeal joint range of motion were collected as postoperative outcomes. In total, 29 studies were included. All surgical techniques resulted in satisfactory clinical outcomes, with no significant differences between bone anchor reinsertion, suture fixation, K-wire fixation and a combination of techniques. K-wire immobilization resulted in worse postoperative pain, but similar stability compared to immobilization without a K-wire. Clinical outcomes after thumb UCL repair are excellent, with no differences in clinical outcomes noted among surgical techniques.

Thumb Metacarpophalangeal Joint Kinematics and Elongation of the Ulnar Collateral Ligament

The purpose of the study was to determine if the sphericity of the thumb metacarpophalangeal (MCP) joint influences the joint's rotational axis (RA) and elongation patterns of the ulnar collateral ligament (UCL). Ulnar collateral ligament origins and attachments of 28 fresh-frozen cadaveric thumbs were marked with a radiopaque marker. Lateral radiographs were obtained in neutral and 20°, 40°, and 60° of flexion. The dorsal and palmar joint gap and the length of four different UCL portions were digitally measured in all flexion states. The RA was determined by the intersection of the midshaft axis of the proximal phalanx in neutral and flexion states. Sphericity of the MCP joint was assessed using morphometric parameters. Joints were grouped as round or flat. Differences in all measured parameters between groups were analyzed. During flexion, the dorsal joint gap increased by 322% in flat joints and 163% in round joints. The palmar joint gap decreased to 45% in flat joints and to 87% in round joints. The RA was at 29% of metacarpal height and 96% of metacarpal length in flat joints and at 40% of height and 86% of length in round joints. Maximum UCL elongation (111%) was noted at 40° flexion in the dorsal proper UCL in flat joints and at 60° flexion in the accessory UCL (117%) in round joints. In flat MCP joints, the RA is more dorsal and distal in the metacarpal head compared to round joints, resulting in a hinged flexion motion. Elongation of the UCL is highest at end flexion in round joints and highest at midflexion in flat joints. The different kinematics of flat and round MCP joints may contribute to the understanding of the pathophysiology of UCL ruptures. The propensity of this injury and the position in which they occur may be affected by the MCP joint morphology.

Qualitative Research in Return to Sport: a Current Review of the Literature.

Return to sport (RTS) is an important metric tied to patient satisfaction after receiving treatment for a sports-related injury. Recently, there has been an explosion of literature on RTS; yet a comprehensive review encompassing multiple injuries does not exist. Furthermore, RTS has historically been defined by quantitative measures that assess strength, function, and pain but little consideration has been given to psychologic factors nor has there been an open-ended forum for athletes to share with health care providers which factors they feel are most influential for RTS. This review also serves to heighten surgeons' awareness of underlying psychologic/psychosocial factors affecting RTS. Qualitative studies which employ open-ended questioning of athletes who have undergone surgical management of superior labral anterior-posterior (SLAP) tears, shoulder instability, ulnar collateral ligament (UCL) rupture, femoral acetabular impingement (FAI), and anterior cruciate ligament (ACL) tear demonstrate that fear of reinjury, lack of social support, and unrealistic expectations are all barriers to RTS. Qualitative studies give health care providers unique insight into the perspectives of their patients so that unmet postoperative needs can be addressed to facilitate RTS. Sports psychologists, coaches, athletic trainers, and physical therapists should create a positive environment to address these needs and provide optimal, holistic care to return athletes to the field safely. Though time consuming, further qualitative research is necessary to understand the unique factors affecting RTS in athletes.

Patient-Reported Outcomes and Function After Surgical Repair of the Ulnar Collateral Ligament of the Thumb

The purpose of this study was to report prospectively collected patient-reported outcomes of patients who underwent open thumb ulnar collateral ligament (UCL) repair and to find risk factors associated with poor patient-reported outcomes. Patients undergoing open surgical repair for a complete thumb UCL rupture were included between December 2011 and February 2021. Michigan Hand Outcomes Questionnaire (MHQ) total scores at baseline were compared to MHQ total scores at three and 12 months after surgery. Associations between the 12-month MHQ total score and several variables (i.e., sex, injury to surgery time, K-wire immobilization) were analyzed. Seventy-six patients were included. From baseline to three and 12 months after surgery, patients improved significantly with a mean MHQ total score of 65 (standard deviation [SD] 15) to 78 (SD 14) and 87 (SD 12), respectively. We did not find any differences in outcomes between patients who underwent surgery in the acute (<3 weeks) setting compared to a delayed setting (<6 months). We found that patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline. We did not find an association between injury to surgery time and lower MHQ total scores. This suggests that acute repair for full-thickness UCL tears might not always be necessary. Therapeutic II.

A case series of Stener’s lesion of the first metacarpophalangeal joint

Ulnar collateral ligament (UCL) injuries have a high prevalence however; these are usually being missed in the initial clinical evaluation. Depending on the chronicity of the injury there are two acronyms for UCL tear. One is the skier's thumb and the other is the gamekeeper's thumb. If the UCL of the first metacarpophalangeal joint (MCP joint) has a complete tear with entrapment of aponeurosis of adductor pollicis muscle between the MCP joint and torn ligament, is called a Stener’s lesion. This is a rare clinical entity that requires early surgical correction because of entrapment. The mechanism of injury is the coerced abduction of the thumb from the index finger, causing ligament tears or sprain with or without ensuing avulsion fracture. The incidence of Stener’s lesions associated with UCL rupture has been reported to be up to 52% per intra-operative finding. In Stener’s lesions, the UCL tears from the base of the proximal phalanx (PP) then retracts proximally and displaces superficial to the adductor pollicis. Here we are presenting four cases of Stener’s lesions, with the usefulness of magnetic resonance imaging (MRI) in diagnosing this entity, which can prevent possible long-term complications such as chronic pain, joint degeneration, and joint instability.

Biomechanical comparison of two InternalBrace™ reinforced thumb ulnar collateral ligament reconstruction techniques.

Chronic ulnar collateral ligament ruptures of the thumb metacarpophalangeal joint are often not eligible for direct surgical repair and ligament reconstruction could be considered. Several reconstruction techniques are published, with different types of configurations and fixation methods of the tendon grafts. However, failure of the reconstruction with recurrent instability is still a problem, despite stable graft to bone fixation. Augmentation of the free tendon graft with non-resorbable suture material is gaining popularity, aiming to withstand elongation or rupture of the graft. The purpose of this study was to compare two different augmented ulnar collateral ligament reconstruction methods in a cadaver model. Ten matched pairs of cadaveric upper extremities were used. The thumbs were disarticulated at the trapezometacarpal joint and the ulnar collateral ligament was excised then reconstructed with InternalBrace™ reinforced tendon graft, which was fixed to the bones using either a Tenodesis screw or DX Swivelock® anchor. The thumbs were biomechanically tested with valgus stress, while the force and displacement were simultaneously measured and plotted. The mean (SD) load at clinical failure and maximum load were 19.4 (5.3) and 31.4 (9.5) N in the Tenodesis group, and 21.0 (10.0) and 31.4 (13.9) N in the DX SwiveLock® group, respectively. None of these differences were significant. These results are comparable with previous publications. The Tenodesis screw and the DX SwiveLock® thumb ulnar collateral ligament reconstruction with InternalBrace™ reinforced free tendon graft showed equal strength, both methods are feasible alternatives in the clinical setting.

Traumatic Great Toe MCL Avulsion in Professional Athlete Treated Surgically with MCL Repair with Suture Tape Augmentation Allowing Rapid Return to Sport

Category: Sports; Midfoot/Forefoot; Trauma Introduction/Purpose: Acute medial collateral ligament (MCL) tears of the great toe metatarsophalangeal joint (MTPJ) are a rare occurrence. There is minimal literature existing regarding both operative and non-operative management of this pathology, also known as 'traumatic bunion' due to its low incidence. The closest analog is a traumatic ulnar collateral ligament (UCL) rupture in the hand (Skier's thumb). Suture anchor repair with an internal brace has proven to be an effective treatment for thumb UCL tears with rapid rehabilitation and early range of motion. This method has not yet been reported in literature for a weightbearing joint such as the hallux MTPJ. We present a case report for a professional surfer with traumatic great toe MCL avulsion with surgical technique allowing rapid return to sport. Methods: We present a case report of a novel technique for this rare traumatic MCL avulsion. Surgical management of the great toe MCL was performed utilizing a pre-loaded interference screw to fixate suture at the MCL origin with suture tape augmentation. A mid-axial medial approach was used with L-shaped capsular flap to expose the MCL. 3-0 braided suture was passed through the proximal avulsed MCL. A drill tunnel was prepared at the MCL origin, and the MCL was repaired to its anatomic origin with an interference screw technique for knotless technique. The interference screw was preloaded with suture tape. The suture tape from the interference screw was passed extra articular and the capsule was repaired. The sutuer tape was then inserted into the MCL insertion on the distal phalanx using a small interference screw and drill tunnel for a suture tape augmentation while the toe was held in neutral MTPJ position. Results: He was made weightbearing as tolerated in a CAM boot post-operatively. Immediate active great toe MTPJ motion was permitted. At 2 weeks post-op, sutures were removed, and he was allowed self-directed passive range of motion of the toe, with continued weightbearing as tolerated in the boot. All restrictions were lifted at 4 weeks for a return to play protocol and the patient resumed surfing immediately at that time. His last follow up appointment was at 3 months post-op, at which time he had resumed full activity, had no deformity recurrence, no pain, and his range of motion was symmetric to the contralateral foot. The patient was able to compete at full activity in a national tournament to continue the professional tour at 3 months post- operatively. Conclusion: This report demonstrates a novel surgical technique for the treatment of a rare traumatic MCL avulsion of the great toe (the 'traumatic bunion'). In this case of great toe MCL repair in a professional surfer, we utilized a knotless technique to repair the MCL to it's anatomic origin and also provide suture tape augmentation to allow rapid rehabilitation. This report demonstrates rapid return to sport, an excellent outcome, easy rehabilitation, and straightforward surgical technique. More research will be needed to demonstrate the success of this technique in a broader population.

Elbow Injuries in Children

Elbow Injuries in Children

Tension Control UCL Reconstruction With Internal Brace Augmentation

Background:Ulnar collateral ligament (UCL) rupture is a common injury, particularly in throwing athletes. It occurs either in the acute setting or due to repetitive microtrauma. UCL reconstruction has been a successful treatment with proper patient selection. A number of different surgical techniques have been described in the literature. We developed a novel surgical technique using internal brace augmentation to address the 2 most common causes of failure: suture failure and bone tunnel fracture.Indications:To provide information about this novel UCL reconstruction technique.Technique Description:The palmaris longus graft is harvested and prepared to be used as the autograft. A 5-cm curved incision is made over the medial epicondyle of the humerus. The UCL reconstruction is then performed using the double suspensory reconstruction technique followed by an internal brace augmentation.Results:Excellent clinical outcomes and high return to sports rates have been reported after UCL reconstruction. In this novel technique, the addition of the internal brace provides secondary interference fixation of the graft on the humeral side along with the additional support the brace itself provides.Discussion/Conclusion:Using internal brace augmentation increases the stability of the UCL reconstruction while preventing suture failure and bone tunnel fracture.

Baseball Players Exhibit Symptoms of Posttraumatic Stress Disorder After Ulnar Collateral Ligament Rupture (124)

Objectives:The significant psychological impact and prevalence of posttraumatic stress disorder (PTSD) have been thoroughly documented in multiple investigations of patients after anterior cruciate ligament ruptures, but this has not yet been assessed in patients after ulnar collateral ligament (UCL) rupture. Our hypothesis is that symptoms of PTSD are present among baseball players after UCL injury.Methods:Baseball players, from the high school to minor league baseball level who had suffered an acute UCL rupture were recruited at a tertiary care center. Patients completed the Horowitz Impact of Event Scale - Revised (IES-R) to analyze for PTSD symptomatology.Results:A total of 24 patients were enrolled. The mean patient age was 19.2 years (range 15-24 years). Twenty patients (83.3%) were pitchers; 12 pitched exclusively. Six patients surveyed played at the high school level (25%), 15 in college (62.5%), and 3 at the minor league level (12.5%). 100% of patients were male. Over 91% of patients experienced symptoms of intrusion, 87.5% displayed avoidance symptoms, and 79.2% had symptoms of hyperarousal. Twelve patients (50%) scored >24 on the IES-R (PTSD is a clinical concern). 6 patients (25%) reached the threshold for a probable diagnosis of PTSD (³33 on the IES-R).Conclusions:Following UCL rupture, athletes experience substantial emotional trauma, and a significant proportion of patients experience symptoms severe enough to warrant a diagnosis of PTSD.

Rupture Site Location of Surgically Treated Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligaments

PurposeThumb metacarpophalangeal collateral ligament injuries occur in 50 per 100,000 people. The most frequent rupture site locations that are often cited are the thumb ulnar collateral ligament (UCL) occurring distally from the proximal phalanx and the radial collateral ligament (RCL) occurring proximally from the metacarpal head.2,16 In this study, we report the frequency of the rupture site location of both thumb UCL and RCL injuries.MethodsA retrospective analysis of 1,004 consecutive finger collateral ligament surgeries performed at a single academic institution over 17 years was conducted. The inclusion criteria were any patient who underwent either a thumb UCL or RCL surgical repair. Patients were excluded if the rupture etiology was secondary to a laceration or a congenital or chronic deformity. Descriptive statistics were presented.ResultsThree hundred forty-seven patients were included in this study, including 288 thumb UCL injuries and 59 thumb RCL injuries. The rupture site location for the thumb UCL was proximal in 5.9% (n = 17) of the cases, distal in 92.7% (n = 267), and midsubstance in 1.4% (n = 4). Fifty-three (18.4%) Stener lesions were noted. The rupture site location for the thumb RCL was proximal in 69.5% (n = 41) of the cases, distal in 25.4% (n = 15), and midsubstance in 5.1% (n = 3).ConclusionsIn thumb UCL ruptures, the rupture site occurred most often at the proximal phalanx, whereas RCL injuries occurred most often at the metacarpal head. Overall, there was greater heterogeneity of RCL rupture site location frequency. Careful surgical exposure should be performed when repairing either the UCL or RCL. Further studies will determine if differences in rupture site location portend a difference in prognosis.Type of study/level of evidencePrognostic III.

Primary Repair of Proximal Ulnar Collateral Ligament Ruptures in Pediatric Overhead Athletes

Ulnar collateral ligament (UCL) injury is commonly seen in overhead throwing athletes resulting from the repetitive valgus stress placed on the medial elbow. UCL injuries (attenuation, insufficiency, or rupture) can result in medial elbow pain, a loss of pitch velocity and accuracy, and increased fatigue. Diagnosis can be made by performing a thorough physical examination along with imaging if indicated, such as ultrasound or magnetic resonance imaging. Treatment options include nonoperative in recreational athletes or those whose primary positions in sport are not high-volume throwing, such as position players in baseball. If nonoperative treatment fails, or the patient has potential for future high-level overhead activity such as a baseball pitcher, surgical repair or reconstruction may be indicated. This article describes our surgical technique for UCL repair in pediatric baseball pitchers.

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.

Suture tape augmentation of the lateral ulnar collateral ligament increases load to failure in simulated posterolateral rotatory instability.

Simple elbow dislocations are accompanied with lateral ulnar collateral ligament ruptures. For persisting instability, surgery is indicated to prevent chronic posterolateral rotatory instability. After lateral collateral ligament (LCL) complex repair the repair is protected by temporary immobilization, limited range of motion and hinged bracing. Internal bracing is an operative alternative augmenting the LCL repair using non-absorbable suture tapes. However, the stability of LCL repair with and without additional augmentation remains unclear. The hypothesis was that LCL repair with additional suture tape augmentation would improve load to failure. Secondary goal of this study was to evaluate different humeral fixation techniques. A humeral fixation using separate anchors for the LCL repair and the augmentation was not expected to provide superior stability compared to using only one single anchor. Twenty-one elbows were tested. A cyclic varus rotational torque of 0.5-3.5Nm was applied in 90°, 60°, 30°, and 120° elbow flexion to the intact, torn, and repaired LCLs. The specimens were randomized into three groups: repair alone (group I), repair with additional internal bracing using two anchors (group II), repair using one humeral anchor (group III). A load-to-failure protocol was conducted. Load to failure was significantly higher in groups II (26.6Nm; P = 0.017) and III (23.18Nm; P = 0.038) than in group I (12.13Nm). No significant difference was observed between group II and III. All specimens lost reduction after LCL dissection by a mean of 4.48° ± 4.99° (range 0.66-15.82). The mean reduction gain after repair was 7.21° ± 4.97° (2.70-21.23; mean over reduction, 2.73°). The laxity was comparable between the intact and repaired LCLs (n.s.), except for varus movements at 30° in group II (P = 0.035) and 30° (P = 0.001) and 120° in group III (P = 0.008) with significantly less laxity. Inserting the ulnar suture anchor showed failure in the thread in 10 cases. LCL repair with additional internal bracing yielded higher load to failure than repair alone. Repair with additional internal bracing for the humeral side using one anchor was sufficient. A higher primary stability would facilitate postoperative management and allow immediate functional treatment. Reducing the number of humeral anchors would save costs.

Performance, Return to Play, and Career Longevity After Ulnar Collateral Ligament Reconstruction in Professional Catchers

The purpose of our study was to evaluate return to play and postinjury performance of professional catchers who sustained an ulnar collateral ligament (UCL) rupture requiring surgical reconstruction. We looked to evaluate these players to determine the rate of return to play, the level of return to play, and career longevity after surgery as well as how statistical performance is affected by reconstruction. Twenty-five professional catchers who underwent UCL reconstruction between 1985 and 2015 were identified and compared with an age-, position-, and competition-matched control group. Priority was placed on level of play, year of injury, age, and years played prior to injury in matching controls. Injury information and demographic data (age at injury, level of play, and career length) were collected from publicly available team websites and press releases. Offensive and defensive performance statistics were collected for 3years prior to injury and 3years after return. Return to play, return to level of play, and career after return were also analyzed. The average age at time of UCL injury was 24.4 (standard deviation, 4.5) years old. Return to play for all catchers was 80% (20/25), with only one player not returning to the same previous level of play (95%). Average years in Major League Baseball (MLB) after return was 2.3years versus 2.6years in the control group (P= .07), with 4.3years total (MLB and minors) versus 3.8years total in the control group (P= .28). There were no changes in offensive or defensive performance before and after injury. UCL reconstruction in professional catchers can lead to successful outcomes. Catchers can expect a high rate of return to play with high rate of return to previous level of play, similar performance, and no change in career longevity following return from UCL reconstruction. Level III, case-control series.

The Stener Lesion: Historical Perspective and Evolution of Diagnostic Criteria.

In 1962, Bertil Stener first described the anatomy and treatment of the displaced ulnar collateral ligament of the metacarpophalangeal joint, later called the Stener lesion. Since Stener's publication, treatment algorithms for ulnar collateral ligament rupture have aided in preoperative diagnosis, yet the best diagnostic method to assess ligament displacement remains largely undefined. An extensive literature search was performed to explore the treatment evolution of the Stener lesion and explore how technical development has influenced Stener lesion diagnosis. We also sought to illuminate the life and work of Bertil Stener. Studies evaluating the use of magnetic resonance imaging (MRI) and ultrasound (US) technology have suggested that these modalities have improved Stener lesion diagnosis. Despite the utility of developing MRI and US technology, consensus for one superior diagnostic tool for Stener lesions does not currently exist.

Arthroscopic repair of thumb metacarpophalangeal ligament injuries – a prospective series

Thumb metacarpophalangeal sprains are one of the most common hand injuries + as others joint trauma, arthroscopic management may enhance results while decreasing morbidity. The aim of this work was to improve surgical recovery and outcomes in thumb metacarpophalangeal collateral ligament ruptures using a new and simple arthroscopic repair. We experimented first the procedure on 8 cadaveric thumbs then we initiate a prospective series including all surgical acute (< 3 weeks) ligament ruptures without avulsion fractures. Over a period of 2 years, 17 patients [14 ulnar collateral ligament (UCL) and 3 radial collateral ligament (RCL) injuries] were included. Diagnosis was obtained using a bilateral examination, X rays and ultrasound. We used a 1.9 mm arthroscope with only two 2 mm-long portals - one optical portal (dorsolateral for UCL injuries, dorsomedial for RCL injuries) and one instrumental portal near of the collateral ligament rupture. Through this instrumental portal, we were able to reduce the Stener lesion and repair ligaments using a 2 mm titanium suture screw anchor. A splint was kept for 3 weeks followed by physiotherapy. A postoperative X ray was performed to confirm the anchor position then physical examination after 3, 6 and 12 weeks. Analysis criteria were: – preoperative - demographic data, diagnosis conditions; – perioperative - duration of the surgery, all ligament lesions observed at 360°; – postoperative - MP range of motion and KeyPinch strength, pain, stability testing, time off work, potential complications (scare, nerve damage). All patients were reviewed three times. Preoperative criteria - all preoperative radiographic volar subluxations were associated with the arthroscopic report of a complete rupture of at least one part (accessory or proper part) of the collateral ligament. Peroperative criteria - duration of surgery was 24 minutes (15–32). Ligament assessment - all UCL ruptures were distal (n = 14), all RCL ruptures were proximal (n = 3), 5 accessory collateral ligament damages were contralateral to the main ligament rupture. Postoperative criteria - in UCL ruptures (n = 14), postoperative X rays demonstrated that all anchors were localized in the palmar half of the phalanx, 12 in the palmar third. About strength and motion - at 3 weeks - ROM - 50%, KeyPinch - 35% + 6 weeks - ROM - 85%, KeyPinch - 68% + 12 weeks - ROM - 90%, KeyPinch 87%. None chronic instability and none dorsal sensitive nerve damage were noticed. Arthroscopic repair of thumb metacarpophalangeal injuries enables a precise ligamentous diagnosis. This is a safe procedure to perform an accurate repair and achieve a quick recovery with excellent outcomes.

Arthroscopic repair of thumb metacarpophalangeal ligament injuries: A prospective series

Thumb metacarpophalangeal sprains are one of the most common hand injuries; as others joint trauma, arthroscopic management may enhance results while decreasing morbidity. The aim of this work was to improve surgical recovery and outcomes in thumb metacarpophalangeal collateral ligament ruptures using a new and simple arthroscopic repair. We experimented first the procedure on 8 cadaveric thumbs then we initiate a prospective series including all surgical acute (< 3weeks) ligament ruptures without avulsion fractures. Over a period of 2 years, 17 patients [14 ulnar collateral ligament (UCL) and 3 Radial collateral ligament (RCL) injuries] were included. Diagnosis was obtained using a bilateral examination, X-rays (without stress) and US. We used a 1,9-mm arthroscope with only two 2-mm-long portals: one optical portal (dorsolateral for UCL injuries, dorsomedial for RCL injuries) and one instrumental portal near of the collateral ligament rupture. Through this instrumental portal, we were able to reduce the Stener lesion and repair ligaments using a 2-mm titanium suture screw anchor. A splint was kept for 3 weeks followed by physiotherapy. A postoperative X-ray was performed to confirm the anchor position then physical examination after 3,6 and 12 weeks. Analysis criteria were: – preoperative: demographic data, diagnosis condition; – perioperative: duration of the surgery, all ligament lesions observed at 360°; – postoperative: MP range of motion and key-pinch strength, (% of the contralateral side), pain, stability testing, time off work and sports, potential complications (scare, sensitive nerve damage). All patients were reviewed three times. Preoperative criteria: all preoperative radiographic volar subluxations were associated with the arthroscopic report of a complete rupture of at least one part (accessory or proper part) of the collateral ligament. Peroperative criteria: duration of surgery was 24 minutes (15–32). Ligament assessment: all UCL ruptures were distal (n = 14), all RCL ruptures were proximal (n = 3), 5 accessory collateral ligament damages were contralateral to the main ligament rupture. Postoperative criteria: in UCL ruptures (n = 14), postoperative X-rays demonstrated that all anchors were localized in the palmar half of the phalanx, 12 in the palmar third. About strength and motion: after 3 weeks: ROM: 50%, Key-pinch: 35%. After 6 weeks: ROM: 85%, key-pinch: 68%. After 12 weeks: ROM: 90%, key-pinch 87%. None chronic instability and none dorsal sensitive nerve damage were noticed. Time off work was 3 weeks (0–8). Arthroscopic repair of thumb metacarpophalangeal injuries enables a precise ligamentous diagnosis. This is a safe procedure to perform an accurate repair and achieve a quick recovery with excellent outcomes.

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.

Early Active Mobilization Following UCL Repair With Mitek Bone Anchor

Ulnar collateral ligament (UCL) injuries of the thumb are common. Surgical repair is accepted as the treatment of choice for complete rupture of the ligament. Biomechanical studies have suggested that Mitek bone anchor repairs are potentially safe and strong enough to allow early controlled active mobilization. To date, there have been no studies to compare early active mobilization following Mitek bone anchor repair to standard postoperative rehabilitation involving thumb spica immobilization for the first 4 to 6 weeks. We performed a small pilot randomized control trial to assess the outcome of this new rehabilitation technique to that of standard immobilization following UCL repair with Mitek bone anchor. Our results show that on average early active mobilization leads to an earlier return to full hand function (6 vs. 8 wk) and an earlier return to work (7 vs. 11 wk). There is no difference in the final range of motion achieved. We suggest that Mitek bone anchor repairs for UCL ruptures are robust enough to allow early active mobilization and that a larger trial is warranted to assess whether early active mobilization is superior to standard rehabilitation.