complications after ucl repair of thumb

UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. 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%. Early diagnosis and treatment. 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. You may also begin strengthening exercises if needed. 1995;18:11611165. A sprained thumb is a common injury among athletes. There were 61 studies eliminated as secondary for being in a language other than English. Please enable it to take advantage of the complete set of features! Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Unilateral injuries: 291 and bilateral injury: 1. POST-OPERATIVE WEEKS 22-24. Hand Clin. HHS Vulnerability Disclosure, Help There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Keywords: The limitations of this systematic review are reliant on the studies analyzed. 25. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 2018;6(4):1-7. [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. In these cases, a new graft may be used to perform a second reconstruction. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 2005;24:217221. 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. Please try again soon. 10. better/same/worse than preoperative status). The range of motion of the MP joint of the thumb following operative repair of the. SYMPTOMS: The thumb may be swollen, bruised and painful. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Bethesda, MD 20894, Web Policies Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Subject demographics are reported in Table 2. 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. 23. Objectives: Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. 1996;25:474477. Before Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. 6. Most times, they won't know until they're in the surgery if the internal brace is appropriate. If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 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. 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. Acute gamekeeper's thumb. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. 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%). Orthop Clin North Am. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Am J Orthop (Belle Mead NJ). 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. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Conflicts of interest The authors report no funding or conflicts of interest. A secondary purpose was to compare graft choice and surgical technique for reconstruction. doi: 10.1097/JSA.0000000000000322. Sixty nine (86.3%) patients had grade 3 tears. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. 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. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Jackson M, McQueen MM. There is currently no consensus on treatment of acute or chronic UCL injuries. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). PMC Moher D, Liberati A, Tetzlaff J, et al.. 1977;59:1421. The anti edema management will continue for several weeks. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. 1999;24:7075. J Hand Surg Am. Thus, the true natural history is yet unknown. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). 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. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Complications after surgical treatment of UCL injury are rare. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Engelhardt JB, Christensen OM, Christiansen TG. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. If your bone is broken, a pin will be used to put it in place. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. 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. Range of motion returns much sooner, too. Bookshelf Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). [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. Kaplan EB. government site. 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*. government site. Meta-analysis of the pooled data was completed. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. 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. Mayo Clinic works with baseball players of all levels, from youth leagues to Major League Baseball, to enhance prevention and treatment of ulnar collateral ligament (UCL) injuries, also known as Tommy John injuries. Gamekeepers thumb: a prospective study of functional bracing. Fusetti C, Papaloizos M, Meyer H, et al.. All authors independently performed the search. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. This site needs JavaScript to work properly. 24. *Glickel grading system. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 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. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. J Bone Joint Surg Am. All but 2 were level IV evidence. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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. Epub 2021 Jan 18. 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. 1989;14:567573. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. When assessed, most patients returned to their preinjury employment. An official website of the United States government. This ligament prevents the thumb from pointing too far away from the hand. 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%). Injuries to the PIP joint remain swollen for long periods of time. Van Dommelen BA, Zvirbulis RA. He too had the internal brace augmentation. 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. The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications.