complications after ucl repair of thumb

[23,3638] Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 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. A score of 0 was assigned if the item was either omitted or not performed. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Continuous variable data were reported as mean SDs from the mean. Keywords: After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. POST-OPERATIVE WEEKS 22-24. 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). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Thumb collateral ligament injuries. Benson LS, Bailie DS. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Clin J Sport Med. Long-term results of ligament reconstruction. 14. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Ulnar collateral ligament injuries of the thumb: a comprehensive review. 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. 2022 Mar 1;30(1):e1-e8. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. [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. 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. The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 17. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. The site is secure. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. 1996;25:527530. Bookshelf Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. MCP collateral ligament sprain is most commonly an acute injury related to trauma. 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. Am J Sports Med. Eurasian J Med. Thumb sidedness reported in 3 studies (51 thumbs). 2013;23(4):247-254. Rupture of the. 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. This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. 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. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. You are being redirected to Medscape Education. Orthop Clin North Am. Gamekeepers thumb: a prospective study of functional bracing. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. If the tear is diagnosed later a ligament reconstruction might be a better option. 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%). Please confirm that you would like to log out of Medscape. Please try after some time. Disclaimer. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 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. Data range was reported as minimum to maximum absolute values. Arthritis Rheum. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. 22. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Federal government websites often end in .gov or .mil. Hand Clin. 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. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. The site is secure. may email you for journal alerts and information, but is committed A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. 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. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. Acute gamekeeper's thumb. Some error has occurred while processing your request. PMC The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. No study directly compared the different types of graft for UCL reconstruction. your express consent. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. [17,34] Anywhere from 14% to 64% of UCL injuries have associated Stener lesions, which occur when the adductor aponeurosis is interposed between the ruptured end of the UCL and its site of proximal phalanx attachment. 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. Thirty-two thumbs were treated nonoperatively and 261 operatively. Am J Sports Med. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Mean subject age was 33.9 years. Catalano LW III, Cardon L, Patenaude N, et al.. Van Dommelen BA, Zvirbulis RA. Thumb dominance reported in 8 studies (168 thumbs). Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. All rights reserved. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Early and late postoperative complications were recorded. FOIA Doi: 10.1177/2325967118769328. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Wong TC, Ip FK, Wu WC. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Your surgeon is the person best able to help you avoid any serious recovery problems. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. If your bone is broken, a pin will be used to put it in place. Chir Main. *Glickel grading system. A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. 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. Abrahamsson SO, Sollerman C, Lundborg G, et al.. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). Am J Sports Med. 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. 1998;23:503506. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Only prospective studies can determine this injury course. Thus, the true natural history is yet unknown. You will receive email when new content is published. 7. The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. 44. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery.