Thus, the true natural history is yet unknown. No study directly compared nonoperative to operative treatment. Arthritis Rheum. The mean time from reported injury date to surgery was 202.4 days (2-5969). FOIA 14. Epub 2021 Jan 18. There is currently no consensus on treatment of acute or chronic UCL injuries. Arthrosc Sports Med Rehabil. Systematic review and meta-analysis. and transmitted securely. Data sources: Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Because patients can start moving the thumb within days, it also mitigates some of the negative consequences of prolonged immobilization, such as stiffness and muscle atrophy. The https:// ensures that you are connecting to the 23. 1977;59:1421. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. 8600 Rockville Pike Mechanism of injury to the RCL of the MCP joint of the thumb is force . The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. Benson LS, Bailie DS. Kuz JE, Husband JB, Tokar N, et al.. All rights reserved. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. All but 2 were level IV evidence. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. National Library of Medicine For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Exercises: Gradually progress to competitive throwing and sports . The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). The UCL is also known as the medial collateral ligament or "Tommy John Ligament". If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. official website and that any information you provide is encrypted 1,5,9,10 In acute cases of complete tears involving high-level . to maintaining your privacy and will not share your personal information without Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 2009;34:304308. Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. Long-term results of ligament reconstruction. J Bone Joint Surg Am. This site needs JavaScript to work properly. Orthop Rev. 2009;6:e1000097. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Orthop J Sports Med. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Clipboard, Search History, and several other advanced features are temporarily unavailable. Complications after surgery were rare. Furthermore, it is interesting that our study quality results using the Quality Appraisal Tool were as low as they were (mean 54% with a range of 33%-79%). An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. the thumb. American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. Fourteen articles were included and analyzed (293 thumbs). They may even tear completely. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Bean CH, Tencer AF, Trumble TE. 22. Am J Sports Med. Dr. Holt will talk to you about when it is safe to return to work. Purpose: Before PMC Orthop Clin North Am. Mean study follow-up was 42.8 months. 21. POST-OPERATIVE WEEKS 22-24. J Hand Surg Br. National Library of Medicine Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. 45. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 7. SAGE Open Med. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Categorical variable data were reported as frequency with percentages. 2009;61:623632. Surgical techniques and a review of 70 patients. 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.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. There is also significant performance bias, as there are multiple different methods of treatment, providers, graft, suture, and fixation types, as well as methods and duration of immobilization. Abstract. Mean study follow-up was 42.8 months. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. 39. Please enter a Recipient Address and/or check the Send me a copy checkbox. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. There are some cases where the fusion is not successful and you will still have pain in . 38. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. Am J Sports Med. PMC Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. If the latter was executed only partially, a score of 1 was assigned. Keywords: There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). There is, however, agreement on the treatment goals for repair or reconstruction of the UCL, which are to obtain and maintain an anatomic reduction of the MP joint, reproduce the anatomic origin and the insertion of native ligament, ensure sufficient strength to allow early range of motion, and minimize donor site morbidity if autograft is used.19 Although most surgical undertakings result in good clinical and functional outcomes, there are postoperative complications, including stiffness and decreased range of motion (specifically, restricted flexion at the MP joint), failed reconstruction, infection, neuropraxia, continued pain, implant failure, graft failure, loosening, scarring, and arthrosis.30,43,44 It has been well documented that direct suture techniques fail in chronic injuries.33,45 When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.46. Unauthorized use of these marks is strictly prohibited. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Jupiter JB, Sheppard JE. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). eCollection 2021 Mar. the splint for protection or at night until twelve weeks after the operation. Your surgeon is the person best able to help you avoid any serious recovery problems. MCP fusion was performed . NR, not reported. Main results: Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. 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. Careers. better/same/worse than preoperative status). 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. A systematic review of ulnar collateral ligament reconstruction techniques. 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*. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.30 The stability of the MP joint derives from joint congruity, the true and accessory collateral ligaments, the volar plate, and the surrounding intrinsic muscles.31 The adductor pollicis supplies active support on the ulnar aspect, whereas the abductor pollicis brevis and flexor pollicis brevis provide dynamic stability on the radial border. Your surgeon will discuss these options with you. Complications after surgical treatment of UCL injury are rare. This website also contains material copyrighted by 3rd parties. J Hand Surg Am. [38] Chuter et al[40] 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. Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. Ulnar collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. 11. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. 1976;58:106112. *Glickel grading scale. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. The LUCL is located on the lateral or outside part of the elbow. Objectives: History. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Fourteen articles were included and analyzed (293 thumbs). To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. There were 200 acute injuries and 93 chronic injuries. Continuous variable data were reported as mean SDs from the mean. 1994;23:797804. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Descriptive statistics were calculated. Click the topic below to receive emails when new articles are available. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Jackson M, McQueen MM. J Hand Surg Glob Online. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 32. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis.15,39 It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament.15 In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.15.

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