complications after ucl repair of thumb

Wolters Kluwer Health, Inc. and/or its subsidiaries. Fourteen articles were included and analyzed (293 thumbs). Early and late postoperative complications were recorded. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. A sprained thumb is a common injury among athletes. Complications after surgery were rare. POST-OPERATIVE WEEKS 22-24. 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. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Please enable it to take advantage of the complete set of features! 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. modify the keyword list to augment your search. An official website of the United States government. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. What Happens If We Sit for More Than 8 Hours Per Day? Epub 2021 Jan 18. 31. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 19. Before Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 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. Am J Sports Med. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Data is temporarily unavailable. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. There is currently no consensus on treatment of acute or chronic UCL injuries. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Epub 2013 Nov 12. [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. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. *Glickel grading scale. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. There are some cases where the fusion is not successful and you will still have pain in . Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. 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. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Objectives: 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Treatment of chronic injuries of the. 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. 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*. Orthop J Sports Med. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Gamekeepers thumb: a prospective study of functional bracing. Sports Health. 13. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. There were 61 studies eliminated as secondary for being in a language other than English. Only prospective studies can determine this injury course. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. may email you for journal alerts and information, but is committed J Bone Joint Surg Am. Symptoms are dependent on the cause and severity of injury to the UCL. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 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%). Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. There were 200 acute injuries and 93 chronic injuries. Thirty-two thumbs were treated nonoperatively and 261 operatively. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). The grip strength and the pinch strength were 94.3% and 92.27%,. 2009;34:304308. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Clipboard, Search History, and several other advanced features are temporarily unavailable. The https:// ensures that you are connecting to the Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 36. National Library of Medicine Early diagnosis and treatment. Quantitative outcome of surgical repair. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). MCP fusion was performed . Catalano LW III, Cardon L, Patenaude N, et al.. eCollection 2021 Mar. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 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. This article provides a review of . HHS Vulnerability Disclosure, Help Posner MA, Retaillaud JL. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Disclaimer. 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. Please enable scripts and reload this page. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. [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]. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Please try after some time. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.32 The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.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.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.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. 10. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. 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. If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Accessibility Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. 1,5,9,10 In acute cases of complete tears involving high-level . Kuz JE, Husband JB, Tokar N, et al.. Complications after surgical treatment of UCL injury are rare. Epub 2020 Jun 29. 24. Arthrosc Sports Med Rehabil. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. Am J Sports Med. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. A score of 2 was assigned if the item was completely and accurately performed and reported. There is currently no consensus on treatment of acute or chronic UCL injuries. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. UCLR case series that contained complications data were included. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. If the latter was executed only partially, a score of 1 was assigned. Possible complications include: - Am J Sports Med. Bookshelf 1994;25:2123. Am J Sports Med. and transmitted securely. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. HHS Vulnerability Disclosure, Help Causes. For example, it can be removed when performing . The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. Continue to stretch before and after throwing . Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention.. The range of motion of the MP joint of the thumb following operative repair of the. 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. UCLR case series that contained complications data were included. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Chir Main. 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. If it is appropriate, then surgical consent probably happened before the surgery. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. These tears often occur as a result of a radially directed force on an extended thumb. 11. and transmitted securely. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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%). No study reported the outcomes of nonoperative management of chronic UCL injury. 23. Doi: 10.1177/2325967118769328. [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. Meta-analysis of the pooled data was completed. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Please confirm that you would like to log out of Medscape. To date, no literat. UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. Gamekeeper's thumb. The mean patient age was 37.8 years (14.0-78.1). This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. No study directly compared the different types of graft for UCL reconstruction. J Bone Joint Surg Am. 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. 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.