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.

Efficacy of a radial-based thumb metacarpophalangeal-stabilizing orthosis for protecting the thumb metacarpophalangeal joint ulnar collateral ligament

STUDY DESIGN

Basic research (biomechanics).

INTRODUCTION

The high degree of motion that occurs at the thumb metacarpophalangeal (MCP) joint must be taken into account when immobilizing a partially torn or repaired thumb ulnar collateral ligament.

PURPOSE OF THE STUDY

To determine the efficacy of a radial-based thumb MCP-stabilizing orthosis in resisting abduction across the thumb ulnar collateral ligament.

METHODS

Ten fresh cadaveric hands were mounted to a custom board. An anteroposterior radiograph of the thumb was obtained with a 2 N preload valgus force applied to the thumb, and the angle between the Kirschner wires was measured as a baseline. Subsequently, 20, 40, 60, 80, and 100 N valgus forces were applied 15 mm distal to the MCP joint. Anteroposterior radiographs of the thumb were obtained after each force was applied. The angle of displacement between the wires was measured and compared with the baseline angle. The angles were measured with an imaging processing tool. A custom radial-based thumb MCP-stabilizing orthosis was fashioned for each cadaveric thumb by a certified hand therapist. The aforementioned loading protocol was then repeated.

RESULTS

The radial-based thumb MCP-stabilizing orthosis significantly reduced mean abduction angles at each applied load.

DISCUSSION

We found that our orthosis, despite being hand-based and leaving the thumb IP and CMC joints free, significantly reduced mean abduction angles at each applied load.

CONCLUSIONS

This investigation provides objective evidence that our radial-based thumb MCP-stabilizing orthosis effectively reduces the degree of abduction that occurs at the thumb MCP joint up to at least 100 N.

LEVEL OF EVIDENCE

n/a (cadaveric).

Return to football and long-term clinical outcomes after thumb ulnar collateral ligament suture anchor repair in collegiate athletes

PURPOSE

To evaluate return to play after complete thumb ulnar collateral ligament (UCL) injury treated with suture anchor repair for both skill position and non-skill position collegiate football athletes and report minimum 2-year clinical outcomes in this population.

METHODS

For this retrospective study, inclusion criteria were complete rupture of the thumb UCL and suture anchor repair in a collegiate football athlete performed by a single surgeon who used an identical technique for all patients. Data collection included chart review, determination of return to play, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) outcomes.

RESULTS

A total of 18 collegiate football athletes were identified, all of whom were evaluated for follow-up by telephone, e-mail, or regular mail at an average 6-year follow-up. Nine were skill position players; the remaining 9 played in nonskill positions. All players returned to at least the same level of play. The average QuickDASH score for the entire cohort was 1 out of 100; QuickDASH work score, 0 out of 100; and sport score, 1 out of 100. Average time to surgery for skill position players was 12 days compared with 43 for non-skill position players. Average return to play for skill position players was 7 weeks postoperatively compared with 4 weeks for non-skill position players. There was no difference in average QuickDASH overall scores or subgroup scores between cohorts.

CONCLUSIONS

Collegiate football athletes treated for thumb UCL injuries with suture anchor repair had quick return to play, reliable return to the same level of activity, and excellent long-term clinical outcomes. Skill position players had surgery sooner after injury and returned to play later than non-skill position players, with no differences in final level of play or clinical outcomes. Management of thumb UCL injuries in collegiate football athletes can be safely and effectively tailored according to the demands of the player's football position.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Fluoroscopy-assisted stress testing of the thumb metacarpophalangeal joint to assess the ulnar collateral ligament

BACKGROUND

Diagnostic stress testing of ulnar collateral ligament (UCL) injuries of the thumb metacarpophalangeal (MCP) joint is pivotal to determining treatment. Comparison to the uninjured extremity and fluoroscopy-assisted examination are readily available modalities in the assessment of these patients, with 5-10° differences impacting treatment. Comparative examination, however, assumes that both extremities are normally equal, which has never been verified experimentally. Comparison of clinical and fluoroscopic examination has also never been scrutinized.

METHODS

One hundred asymptomatic participants underwent both fluoroscopic and traditional stress examinations to determine maximum passive radial deviation at neutral MCP flexion.

RESULTS

Absolute clinical vs. fluoroscopic differences demonstrated a significant difference of 5.6° (SD 5.1°). Absolute variability between left-to-right measurements was 4.5° (SD 4.1°) and increased significantly as baseline stress deviation increased (R = 0.43; p < 0.001). Left-to-right difference exhibited no correlation to age, gender, or BMI.

CONCLUSIONS

The current investigation demonstrates right-left differences and differences between clinical and fluoroscopic testing of which practitioners should be aware when making treatment decisions for UCL injury of the thumb MCP joint.