Catalano LW III, Cardon L, Patenaude N, et al.. After failure of nonoperative treatment, at anywhere from 6 months to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. [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. Clin Orthop Relat Res. Study design: 18. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). Ulnar Collateral Ligament Repair . 1998;23:503506. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. You've successfully added to your alerts. J Bone Joint Surg Am. What are the symptoms of GameKeeper's Thumb? No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Epub 2019 Mar 21. Eventually this abnormal movement will wear out the joint and it will become arthritic. Complications after surgery were rare. Am J Orthop (Belle Mead NJ). The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Orthop J Sports Med. [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. 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). Treatment of chronic injuries of the. 2006;31:6875. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. There were no cases of intraoperative ulnar nerve injury reported. 2005;87:26322638. Detection bias was present in the inconsistent use of an invalidated outcomes tool (Glickel grading system), visual measurement of range of motion, different tools for strength and stability measurement, and the subjective nature of reporting weakness and stability. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Jackson M, McQueen MM. Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Van Dommelen BA, Zvirbulis RA. 22. If the latter was executed only partially, a score of 1 was assigned. Orthop Clin North Am. A score of 0 was assigned if the item was either omitted or not performed. Methods: Bethesda, MD 20894, Web Policies 1989;17:751753. After significant delay to treatment or even failed nonoperative treatment, excellent clinical outcomes can be achieved, without a difference between initially treating the injury surgically. HHS Vulnerability Disclosure, Help The grip strength and the pinch strength were 94.3% and 92.27%,. A systematic review of multiple medical databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with specific inclusion and exclusion criteria. UCLR case series that contained complications data were included. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Only prospective studies can determine this injury course. Hand Surg. [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. Doi: 10.1177/2325967118769328. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. 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%). 34. *Glickel grading scale. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. The https:// ensures that you are connecting to the 5. Please confirm that you would like to log out of Medscape. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. [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. For example, it can be removed when performing . The doctor won't know if the repair is . The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Hand Clin. Epub 2021 Sep 7. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. The LUCL is located on the lateral or outside part of the elbow. Long-term results of ligament reconstruction. Mean study follow-up was 42.8 months. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Your surgeon will discuss these options with you. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. 26. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. A score of 2 was assigned if the item was completely and accurately performed and reported. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Continuous variable data were reported as mean SDs from the mean. Keywords: 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. This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. 13. 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. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Complications If the UCL is ruptured there is a possibility that the distal end may become interposed by the adductor aponeurosis, which is referred to as a Stener lesion (Figure 5). The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. The site is secure. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. The mean patient age was 37.8 years (14.0-78.1). Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Posner MA, Retaillaud JL. HHS Vulnerability Disclosure, Help Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). 8600 Rockville Pike They may even tear completely. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. MeSH Would you like email updates of new search results? Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Thumb dominance reported in 8 studies (168 thumbs). ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. 23. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . government site. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. 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. 2009;61:623632. Weakened grip or reduced thumb range of motion may occur. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. 17. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Your surgeon is the person best able to help you avoid any serious recovery problems. Federal government websites often end in .gov or .mil. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Epub 2013 Nov 12. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Riederer S, Nagy L, Buchler U. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). An official website of the United States government. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation.