All but 2 were level IV evidence. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. The effect of thumb metacarpophalangeal. A score of 2 was assigned if the item was completely and accurately performed and reported. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Study data collected and analyzed included subject demographics, number and gender of the subjects, number of nonoperative thumbs, sidedness, dominance, subject age, subject weight, and body mass index, throwing athlete status, mean duration follow-up, UCL injury classification, location of UCL injury (proximal, midsubstance, or distal), number of subjects with Stener lesions, number of subjects with avulsion fractures, mechanism of injury, injury chronicity (defined by 3 weeks based on repair vs reconstruction treatment dichotomy proposed by Smith in 1977),17 length of symptoms, graft type used (autograft or allograft), and implant used. Complications after this procedure may include nerve or blood vessel damage. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . official website and that any information you provide is encrypted unstable when the thumb is used. For example, it can be removed when performing . Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Injury. 14. Selection bias was presented based on the variance in subject age, gender, hand dominance, injury chronicity, injury location, the presence or absence of bony avulsion, the presence or absence of Stener lesion, and the retrospective nature of most of the studies. Treatment for thumb collateral ligament injury - KW orthopaedics Both repair and reconstruction (autograft and allograft) techniques were inclusive. Metacarpophalangeal joint injuries of the thumb. Fourteen articles were included and analyzed (293 thumbs). Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. 2005;87:26322638. This site needs JavaScript to work properly. If the tear is diagnosed later a ligament reconstruction might be a better option. Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). Bailie DS, Benson LS, Marymont JV. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. Instability of the metacarpophalangeal joint of the thumb. Arthrosc Sports Med Rehabil. Upper extremity injuries in snow skiers. J Hand Surg Am. Throwing status reported in 4 studies. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Clipboard, Search History, and several other advanced features are temporarily unavailable. *Glickel grading scale. Chir Main. Complications after surgery were rare. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Part II: treatment and complications. 33. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. Systematic review and meta-analysis. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Most times, they won't know until they're in the surgery if the internal brace is appropriate. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. eCollection 2021 Mar. These tears often occur as a result of a radially directed force on an extended thumb. Kuz JE, Husband JB, Tokar N, et al.. 11. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Ulnar Collateral Ligament Repair . Range of motion returns much sooner, too. Thumb sidedness reported in 3 studies (51 thumbs). 1998;23:503506. Careers. A score of 0 was assigned if the item was either omitted or not performed. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540). Purpose: #Injury location reported only in 3 studies. You may be trying to access this site from a secured browser on the server. 1995;18:11611165. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Causes. Stretching or even a rupture of the graft is also possible. This article provides a review of . Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary Outcomes After Injury to the Thumb Ulnar Collateral Ligament Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 1989;17:751753. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. Conclusion: Surgical treatment has been advocated for all avulsion fractures of the UCL, as the area of articular cartilage is always greater than the fragment size. Acta Chir Scand. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. Pichora DR, McMurtry RY, Bell MJ. I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. Ulnar collateral ligament injury of the thumb - Wikipedia your express consent. 8. Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). UCL injuries: Defining risk and improving treatment - Mayo Clinic A secondary purpose was to compare graft choice and surgical technique for reconstruction. 2009;61:623632. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. There were no cases of intraoperative ulnar nerve injury reported. MeSH The diagnosis is best established clinically, though MRI is the imaging modality of choice. No study compared different graft types or fixation techniques. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. [32] The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Kozin SH, Bishop AT. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher No study directly compared nonoperative to operative treatment. J Hand Surg Glob Online. abduction-adduction motion. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics Bean CH, Tencer AF, Trumble TE. Complications after surgery were rare. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication.

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