Ulnar Ligament Research Articles

Mid-term results of the treatment of acute postero-lateral rotational instability of the elbow joint

Background: Dislocations of the forearm are rare injuries with the annual incidence of 6.1 cases per 100 000 population. Postero-lateral rotational instability is the most common complication after the conservative treatment of forearm dislocations. To restore the congruency and provide early movements in the elbow joint, the primary repair or reconstruction of the damaged ligaments of the elbow are required. Aim: to evaluate the clinical and functional results after the surgical repair of the elbow joint ligaments in acute postero-lateral rotational instability. Methods: The study was based on a retrospective analysis of a series of clinical cases, including 17 patients with acute postero-lateral rotational instability, among them 5 simple forearm dislocations, 9 fracture-dislocations of the forearm and 3 fractures of the radial head. Refixation of the lateral ulnar ligament was performed with anchor fixation or bone tunnels. The evaluation was performed using the clinical aspects (the lateral pivot shift test, the range of motion), according to the scale for the evaluation of the elbow joint functional condition (MEPS), Oxford scale of the elbow joint evaluation (OEC), the X-ray results were also estimated. Results: In all the cases the elbow joint stability had been achieved, according to the X-ray and clinical aspects. In 4 cases, additional plasty of the medial collateral ligament was needed and performed after the restoration of the lateral ligament complex. According to the MEPS scale, 58% of the achieved results were excellent, 35% were good and 5.8% were satisfactory. Conclusion: The restoration of the lateral ulnar collateral ligament complex is a safe and effective procedure, which restores the elbow joint stability and allows the patients to return to full physical activity and avoid the development of postero-lateral rotational joint instability.

Terrible triad injury of the elbow: a historical perspective.

The aims of this study are to summarize (1) the history of terrible triad injury (TTi) treatment and (2) the clinical and biomechanical data that engendered its evolution. A literature search was performed using fiveelectronic databases. Results were discussed as a chronologic review of the relevant literature between 1920 and 2022. In 1962, Osborne was the first to describe a link between elbow dislocation, radial head fracture, and lateral collateral ligament complex injury via a novel mechanism: posterolateral rotatory instability (PLRI). Given that untreated elbow instability leads to post-traumatic osteoarthritis (PTOA), there has been increasing interest in elbow biomechanics since the 1980s. Data from studies in that period revolutionized the approach to elbow instability. The authors demonstrated that TTi could occur via a PLRI mechanism with a disruption of the lateral collateral ulnar ligament and a functionally competent anterior medial collateral ligament (aMCL). Since the 1990s, due to the difficulty in identifying its pathoanatomic features, some began to speculate about a sequence of injuries and mechanisms leading to TTi. However, the clinical literature has largely been unable to reproduce in vitro findings describing the pathomechanics of TTi. Some aspects of treatment remain controversial including systematic coronoid and aMCL repair. Despite a growing body of biomechanics data, there is no widely accepted surgical protocol for the treatment of TTi. Functional outcomes among patients have greatly improved. Better diagnosis and treatment of infra-clinical instability after a TTi may be an important stepping stone to prevent the onset of moderate/severe PTOA.

Arthroscopic Evaluation of LUCL Stability After Selective Release and Repair of the Lateral Collateral Ulnar Ligament

To perform a selective release and repair of the LUCL of the elbow and arthroscopic assessment of postoperative stability.

Lateral collateral ulnar ligament reconstruction techniques in posterolateral rotatory instability of the elbow: A systematic review

BackgroundElbow chronic instability is a disable complication, presenting as recurrent joint subluxations or dislocations. This systematic review aims to assess (1) the clinical outcome and (2) the complication rates of the surgical techniques currently used in the management of posterolateral rotatory elbow instability. MethodsOVID-MEDLINE®, SCOPUS, and PubMed were searched from January 2009 to February 2019 to identify relevant studies. The search terms used were "LUCL", "Posterolateral dislocation", "Elbow Docking technique", "Elbow Jobe technique" and "Elbow single strand technique". The methodological qualities of the studies were evaluated, relevant data were extracted. ResultsThree studies, published between 2012 and 2015, were included in this review. No studies concerning the single strand technique met the inclusion criteria. The included studies had a level of evidence IV and recruited 33 patients undergoing a Jobe technique reconstruction and 8 patients undergoing a Docking technique. Jobe procedure registered better clinical and functional outcome, assessed using the Mayo Clinic Elbow Performance Scale (MEPS), compared with patients managed with Docking technique. Nonetheless, this difference is not significant. There was not a significantly different complication rate (p = 0.57) between patients treated with these two different techniques. ConclusionThis systematic review showed that both Jobe and Docking techniques are safe and effective in the treatment of posterolateral elbow instability. However, future studies with larger sample size and a longer follow-up interval are needed to draw stronger conclusions on the efficacy of the different LUCL surgical reconstruction techniques.

Stabilization of the radial head with the palmaris longus or the gracilis tendon: an anatomical feasibility study.

The proximal radioulnar joint (PRUJ) and the radiocapitellar joint may be destabilized after trauma. Different techniques for stabilization of PRUJ have been proposed, but none of them can stabilize the radiocapitellar joint at the same time. We propose a ligamentoplasty to stabilize the radial head at these two joints by reconstructing the radial head annular ligament and the lateral collateral ulnar ligament (LCUL) with a single graft (palmaris longus or gracilis tendon of the knee). Fifteen cadaveric upper limbs were used to compare the stabilization obtained by performing our ligamentoplasty with the palmaris longus or the gracilis tendon. For each technique, the stabilization obtained was evaluated by measuring the displacement of the radial head in the anterior, lateral and posterior directions when a force of 1N was applied in maximum supination, neutral rotation and maximum pronation. We also evaluated whether this technique could damage the ulnar nerve or the posterior interosseous nerve by dissecting them and whether it could limit the range of rotation of the forearm. Our ligamentoplasty enables to restore PRUJ stability equivalent to the intact ligament condition. The palmaris longus was inconstant (13/15) and too short to allow concomitant reconstruction of the LCUL (except in one case). No nerve damage was found during the dissection, and the range of rotation of the forearm was not limited by the ligamentoplasty. We also report a clinical case with an excellent result and without complications. This ligamentoplasty we have described makes it possible to stabilize the radial head with respect to the radial notch of the ulna and with respect to the capitellum of the humerus. The gracilis tendon is more suitable than the palmaris longus because of its constant presence and length. A clinical series is now necessary to better evaluate this technique.

In Vivo Mechanical Function of the Distal Radial Ulnar Ligaments During Rotation of the Wrist

The purpose of this study was to investigate changes in length of the volar and dorsal radioulnar ligaments (VRULs and DRULs), and the distal radioulnar joint (DRUJ) space during unweighted and weighted rotation of the wrist using magnetic resonance imaging and biplanar fluoroscopy. Fourteen wrists in 7 normal adult volunteers were imaged to define the 3-dimensional geometry of the DRUJ and the insertion sites of the superficial and deep bundles of the VRULs and DRULs. Subjects were imaged at 10 positions of forearm rotation ranging from full pronation to full supination, with or without a 5-pound weight. Lengths of the superficial and deep VRUL and DRUL bundles and DRUJ space were measured (in millimeters) at each position to evaluate ligament function and DRUJ stability. In the unweighted and weighted trials, maximal elongation of both deep and superficial VRUL bundles occurred in supination and maximal lengths of the deep and superficial DRUL bundles occurred in pronation. Maximum DRUJ space occurred during pronation and a minimum occurred in 30° of supination. In weighted trials, there was a significant increase in deep and superficial VRUL bundle length at positions between 30° of pronation and 30° of supination; however, there was no effect of weight on DRULs length. In weighted trials, there was a significant increase in DRUJ space at positions between full pronation and 15° of supination. This study demonstrates elongation of the VRULs in supination and the DRULs in pronation. There was no evidence of reciprocal loading of superficial/deep ligament bundles on either the dorsal or the volar aspects of the DRUJ. The effect of loading the wrist during rotation was apparent primarily in the VRULs, but not the DRULs. The DRUJ space was lowest at approximately 30° of supination. These results add information to the literature regarding the complicated biomechanics of the triangular fibrocartilage complex and DRUJ. Future work should evaluate changes in biomechanics caused by triangular fibrocartilage complex tears to determine how tear severity and location relate to clinical symptoms.

Efficacy evaluation of dry arthroscopy technique in wrist arthroscopy for wrist joint injury

Objective To investigate the clinical efficacy of dry arthroscopy in the treatment of wrist joint injury. Methods A retrospective case series study was conducted to analyze the clinical data of 59 patients with wrist joint injuries admitted from January 2013 to January 2016. There were 48 males and 11 females, aged 15-69 years, with an average age of 34 years. Among the patients, there were 32 patients with old scaphoid fractures (including delayed diagnosis and treatment of scaphoid fractures or scaphoid fracture nonunion), 23 patients with intra articular fractures of distal radius, and four patients with chronic instability of lower ulnar radial joint. All patients were treated with dry arthroscopic surgery. During the operation, the operation time of bone grafting and the swelling degree of soft tissue around the joint which needed simultaneous incision were observed. Fracture healing, and joint stability were recorded after operation, and wrist function was evaluated by Mayo wrist function score. Results The average operation time of scaphoid bone grafting was 7 minutes. In patients with distal radius fractures requiring simultaneous incision and reconstruction of the lower ulnar radial ligament, there was no significant periarticular swelling, with normal anatomical layer and clear visual field. All patients were followed up for 6-28 months (average 9 months). All the old scaphoid fractures were healed, with the average healing time of 12.6 weeks. All distal radius fractures were anatomically repositioned during operation. All patients with chronic instability of the lower ulnar radial joint were seen stable recovery of the joint, with negative impact test of the lower ulnar and radial joints. The Mayo wrist function score of all patients averaged 95 points. Conclusion Dry arthroscopic technique can improve the efficiency of bone grafting under wrist arthroscopy, reduce the swelling of soft tissue around the joint, maintain clear anatomical layers of soft tissue, promote fracture healing and improve wrist function, especially applicable for wrist arthroscopy with minimally invasive bone grafting and wrist incision at the same time. Key words: Wrist injuries; Arthroscopy; Scaphoid bone; Radius fractures

Motion deficit in nodal interphalangeal joint osteoarthritis by digital goniometer in housewives.

Range of motion (ROM) measured objectively in nodal hand osteoarthritis (NHOA) is missing. Evaluation of collateral ligaments by ultrasound (US) is unknown in NHOA also. To compare ROM in interphalangeal joints in housewives with nodal OA, with a control group by a digital system using angle to voltage (Multielgon). The second objective was to assess correlation between collateral radial and ulnar ligaments thickness and ROM. For this cross-sectional observational study, we assessed 60 hands with symptomatic NHOA and 30 hands of healthy housewives matched for age. We obtained clinical and demographic characteristics (a complete standardized physical examination of hand joints, DASH questionnaire, pain surveys, gross grasp hand goniometer, and ROM measurements by Multielgon. Presence of synovitis, power Doppler signal, osteophytes, and collateral ligaments thickness was evaluated by US. We used descriptive statistics, Spearman correlation, X2 test, t test and odds ratio. Significant less gross grasp and ROM in the right hand were observed in NHOA (p = 0.01 for both). Presence of OA, painful joints, disease duration, and score DASH were significant correlated with reduced ROM (OR 4.12, 4.12, 1.04 and 1.09, respectively). Reduced ROM was statistical significant in thumb MCP and IP joints, second and third DIP in dominant hand. There was no association between collateral radial and ulnar ligaments and reduced ROM. Synovitis and osteophytes were more prevalent in OA group. Multielgon demonstrated the pattern of reduced ROM in nodal OA of housewives particularly in MCP and IP thumb joints, second and third distal interphalangeal joints.

Ulnar collateral ligament reconstruction of the elbow in posttraumatic and chronic ligament instability

Restoration of ulnar elbow stability in cases of posttraumatic and chronic ulnar ligament instability. Symptomatic therapy-resistant ulnar ligament instability of the elbow. Arthrofibrosis and high-grade elbow arthrosis. Anatomical reconstruction of the ulnar collateral ligament (UCL) with autologous tendon graft (tendons of the palmaris longus muscle and gracilis muscle) in implant-free docking technique. A cast for 1week, then 5weeks orthesis with limitation of complete extension and flexion; full weight bearing after 3months. After 2years 90% of the patients are able to return at anequal level of activity. The overall complication rate is 10.4%. The most common complication is ulnar nerve neurapraxia in 7.8% of the patients.

Trapeziometacarpal Ligaments Biomechanical Study: Implications in Arthroscopy.

Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) often result in pain and is associated with joint instability and a tendency of dorsoradial subluxation. In these instances, arthroscopy may be indicated to: (1) assess the extent of cartilage disease and the laxity of ligaments and to (2) treat TMJ instability. The purpose of our study was to biomechanically analyze which ligaments are the primary stabilizers of the TMJ. Methods Overall, 11 fresh-frozen human cadaver specimens were dissected and attached to a testing device with the thumb positioned in neutral abduction, neutral flexion, and neutral opposition. The four extrinsic and five intrinsic muscle tendons acting on the TMJ were simultaneously loaded with weights proportional to their physiological cross-sectional area. The dorsal, volar, and ulnar groups of ligaments were dissected. A motion-tracking device, FasTrak (Polhemus Inc., Colchester, VT), was used to study the spatial position of the base of the first metacarpal bone (MC1), before and after random sectioning of each of the ligaments. Statistical analysis of the MC1 translation along the transverse XY plane was performed using one-way analysis of variance and a paired t-test, with a significance level of p < 0.05. Results After isolated sectioning of the volar or the ulnar ligaments, the MC1 moved dorsoradially with an average of 0.150 mm (standard deviation [SD]: 0.072) and 0.064 mm (SD: 0.301), respectively. By contrast, the destabilization of the MC1 after sectioning of the dorsal ligaments was substantially larger (0.523 mm; SD: 0.0512; p = 0.004). Conclusion Sectioning of the dorsal ligament group resulted in the greatest dorsoradial translation of the MC1. Consequently, the dorsal ligaments may be regarded as the primary TMJ stabilizers. Clinical Relevance This study suggests that stabilizing arthroscopic shrinkage of the TMJ should be targeted toward the dorsal TMJ ligaments.

In vivo length changes of wrist ligaments at full wrist extension

The aim of this study was to investigate the length changes of carpal ligaments when loaded in full extension in vivo. We obtained computed tomography scans of the right wrists in three positions for six volunteers: neutral; 75° extension; and 75° extension with a further 10° of radial deviation. Nine ligaments were measured and analysed with computer modelling. The results showed that the radioscaphocapitate, long radiolunate, and ulnolunate ligaments lengthened the most at full wrist extension, suggesting that they were under greatest load. The radioscapholunate, ulnocapitate, and ulnotriquetral ligaments lengthened further with the addition of wrist radial deviation. At full extension, the dorsal intercarpal ligament inserting on the scaphoid was lengthened. The dorsal radiocarpal and dorsal intercarpal ligaments inserting on the trapezoid were shortened, suggesting reduced loading. In conclusion, a number of volar carpal ligaments lengthened significantly in full wrist extension and the ulnar carpal ligaments were further lengthened at wrist radial deviation.

Biomechanical Evaluation of the Docking Plus Ulnar Collateral Ligament Reconstruction Technique Compared With the Docking Technique

Background: Surgical techniques for ulnar collateral ligament (UCL) reconstruction have evolved since first described by Jobe. A modified reconstruction technique has been developed, called the docking plus technique, and the authors biomechanically compared it to the commonly performed docking technique. Hypothesis: The docking plus technique for UCL reconstruction will demonstrate greater ligament stiffness than the docking technique. Study Design: Controlled laboratory study. Methods: Ten matched pairs of human cadaveric specimens (mean age ± SD, 52 ± 6 years) were loaded to failure at an elbow flexion angle of 30° at a compressive rate of 14 mm/s. The specimens underwent reconstruction with an autologous graft using the docking plus or docking technique. The reconstructed and native specimens were loaded to failure at the same parameters. Results: The most common mode of failure in the native UCL was midsubstance rupture and avulsion from the ulnar ligament insertion, while the docking plus group failed by suture rupture and the docking group by suture pullout and midsubstance rupture. The mean ± SD stiffness of the native UCL was 21.0 ± 9.0 N/mm, docking plus technique was 11.2 ± 6.6 N/mm, and docking technique was 5.3 ± 1.5 N/mm. The mean stiffness of the docking plus reconstruction was statistically greater (P = .004) than that of the docking technique. The mean ± SD ultimate moment for the native UCL was 35.0 ± 14.0 N·m, docking plus technique was 20.6 ± 7.3 N·m, and docking technique was 8.6 ± 5.1 N·m. The moment across the elbow joint at failure of the docking plus reconstruction was statistically greater (P = .002) than that of the docking technique. Conclusion: The docking plus technique reproduces greater ligament stiffness and demonstrates a higher failure moment immediately after reconstruction than does the docking technique. Clinical Relevance: The docking plus technique allows greater stiffness and a higher moment to failure immediately after reconstruction and describes a way to maintain constant graft tension during fixation, resulting in a biomechanically stronger UCL reconstruction.

Macroscopic and Microscopic Analysis of the Thumb Carpometacarpal Ligaments

Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four ligaments have been described as primary stabilizers, but controversy exists as to which ligaments are most important. We hypothesized that a comparative macroscopic and microscopic analysis of the ligaments of the thumb carpometacarpal joint would further define their role in joint stability. Thirty cadaveric hands (ten fresh-frozen and twenty embalmed) from nineteen cadavers (eight female and eleven male; average age at the time of death, seventy-six years) were dissected, and the supporting ligaments of the thumb carpometacarpal joint were identified. Ligament width, length, and thickness were recorded for morphometric analysis and were compared with use of the Student t test. The dorsal and volar ligaments were excised from the fresh-frozen specimens and were stained with use of a triple-staining immunofluorescent technique and underwent semiquantitative analysis of sensory innervation; half of these specimens were additionally analyzed for histomorphometric data. Mixed-effects linear regression was used to estimate differences between ligaments. Seven principal ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments (dorsal radial, dorsal central, posterior oblique), two volar ligaments (anterior oblique and ulnar collateral), and two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal). The dorsal ligaments were significantly thicker (p < 0.001) than the volar ligaments, with a significantly greater cellularity and greater sensory innervation compared with the anterior oblique ligament (p < 0.001). The anterior oblique ligament was consistently a thin structure with a histologic appearance of capsular tissue with low cellularity. The dorsal deltoid ligament complex is uniformly stout and robust; this ligament complex is the thickest morphometrically, has the highest cellularity histologically, and shows the greatest degree of sensory nerve endings. The hypocellular anterior oblique ligament is thin, is variable in its location, and is more structurally consistent with a capsular structure than a proper ligament.

Study of length changes in the collateral ligament during movement of the metacarpophalangeal joint

Objective To investigate changes in collateral ligament length during flexion and extension of the metacarpophalangeal joint (MCJ) of the four fingers. Methods Spiral CT scans of the MCJ of the index, middle, ring and little fingers were obtained from 6 volunteers. Images from the mid-metacarpal to midproximal phalanx were acquired while the MCJ moved from 0° of flexion to 90° of flexion with 30° inerements.Changes in length of the collateral ligament of MCJ of each individual finger during MCJ movement were analyzed by software processing after three-dimensional image reconstruction of bone structures were obtained. Results During flexion of the MCJ the dorsal bundle of the ulnar and radial collateral ligaments lengthened, while the volar bundle shortened. The length of the middle bundle did not change significantly. Conclusion During MCJ flexion and extension, the collateral ligaments are in a state of tension. However tension in different portions of the ligament varies. There are two main relative movements during MCJ flexion: lengthening of the dorsal bundle of the collateral ligament results in increased tension and shortening of the volar bundle results in decreased tension. The middle bundle always maintains proper tension, restricting and regulating the movement of the joint. Key words: Metacarpophalangeal joint; Collateral ligaments; Movement; Length changes; In vivo study

Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model

Background and purpose Mechanisms of injury to ulnar-sided ligaments (stabilizing the distal radioulnar joint and the ulna to the carpus) associated with dorsally displaced distal radius fractures are poorly described. We investigated the injury patterns in a human cadaver fracture model.Methods Fresh frozen human cadaver arms were used. A dorsal open-wedge osteotomy was performed in the distal radius. In 8 specimens, pressure was applied to the palm with the wrist in dorsiflexion and ulnar-sided stabilizing structures subsequently severed. Dorsal angulation was measured on digitized radiographs. In 8 other specimens, the triangular fibrocartilage complex (TFCC) was forced into rupture by axially loading the forearm with the wrist in dorsiflexion. The ulnar side was dissected and injuries were recorded.Results Intact ulnar soft tissues limited the dorsal angulation of the distal radius fragment to a median of 32o (16–34). A combination of bending and shearing of the distal radius fragment was needed to create TFCC injuries. Both palmar and dorsal injuries were observed simultaneously in 6 of 8 specimens.Interpretation A TFCC injury can be expected when dorsal angulation of a distal radius fracture exceeds 32o. The extensor carpi ulnaris subsheath may be a functionally integral part of the TFCC. Both dorsal and palmar structures can tear simultaneously. These findings may have implications for reconstruction of ulnar sided soft tissue injuries.

Die ligamentäre Instabilität des Ellenbogens: Biomechanische Untersuchungen zur Wertigkeit aktueller Techniken der medialen und lateralen Kollateralbandrekonstruktion

Summary Open surgical reconstruction of the ulnar and lateral ulnar collateral ligament are standard procedures in patients with symptomatic medial or posterolateral rotatory instability of the elbow. There is, however, a considerable discrepancy between the in vivo moments acting on the ulnar or lateral collateral ligament complex during overhead sports activities and the primary stability of current reconstructive methods. This biomechanical study aimed to increase the primary stability of ulnar and lateral ulnar collateral ligament reconstruction either by increasing the diameter of the graft or by using a percutaneous reconstruction procedure which preserves the lateral elbow muscles as important stabilizers of the elbow joint. The results showed that increasing the graft diameter did not provide greater valgus stability because graft passage and graft tensioning was complicated using larger grafts. As the graft diameter did not influence primary valgus stability, future clinical studies should focus on the stabilizing potential of the medial elbow muscles on the valgus stability of the elbow joint. Percutaneous lateral ulnar ligament reconstruction sufficiently restored posterolateral rotatory instability, but clinical trials are needed to prove that preservation of the lateral elbow muscles allows for accelerated rehabilitation and return to sports activities.

Sir Astley Paston Cooper

Sir Astley Paston Cooper

ÜBERKOPFSPORTARTEN: Wurfsportarten in der Leichtathletik

Es finden sich akute Muskelverletzungen im Bereich der Hüftadduktoren und akute Muskel- und Sehnenverletzungen im Bereich der Schultergürtelmuskulatur. Beim Werfen finden sich Überlastungssyndrome der capsulo-labro-ligamentären Strukturen, primäre und sekundäre Instabilitäten, akut traumatische Instabilitäten und das postero-superiore Glenoidimpingement. In track and field, the throwing activities include javelin, discus, shot put and hammer throw. Each one of these throwing disciplines uses its own specific device that needs to be accelerated and then thrown. The throwing motion can be split into a wind-up, a cocking, an acceleration and a follow through phase. Acute injuries of the musculature occur in the hip adductors, while injuries of the musculotendinous junction are found in the shoulder region. Secondary to throwing activities the shoulder can suffer from overuse syndromes of the capsuloligamentous structures, primary and secondary, as well as acute traumatic instability and postero-superior impingement. Following intensive weight training injuries of the chest and back musculature dominate. The thrower's elbow is subjected to problems such as epicondylitis (medial and lateral), and instability of the ulnar ligaments. Degenerative joint disease of the hip, lower spine, elbow and radiocarpal joint are frequently found in these athletes due to chronic overuse. Beginning at an early age, preventive elements should be included in the respective training programs to avoid such problems in the professional athlete.

Medial Collateral Ligament Reconstruction

Medial Collateral Ligament Reconstruction

Early and late surgical treatment of complete rupture of the radial collateral ligament of the first metacarpophalangeal joint

Stability of the first metacarpophalangeal joint is important for daily activities. Rupture of the radial collateral ligament of the first metacarpophalangeal joint (RCL) is less common than rupture of the ulnar collateral ligament, but serious ruptures of the radial ligament are as debilitating as those of the ulnar ligament. Consistent guidelines for treatment of complete RCL rupture have not yet been established. We recommend 4 weeks of immobilization by two K-wires, followed by extensive hand therapy, as primary treatment of complete RCL rupture. As late treatment of complete RCL rupture, we recommend surgical repair using a bone anchor, 4 weeks of immobilization, and subsequent hand therapy. Two patients with a complete RCL rupture are presented. One was treated early and the other received treatment 2 months after injury. These two cases illustrate the methods of early and late treatment.