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Acute Grade III ulnar collateral ligament ruptures

A new surgical and rehabilitation protocol

Department of Surgery, Division of Orthopaedic Surgery, North Shore University Hospital, Manhasset, New York, and the Department of Surgery, Cornell University Medical College, New York, New York

A review is presented here of 36 cases, seen since 1980, of acute Grade III (unstable) sports-related sprains of the thumb metacarpophalangeal joint. In all cases, the injury involved the ulnar collateral ligament. A Stener lesion was present in 97% of cases. Followup was from 2.0 to 8.5 years, the average being 3.9 years. All of the patients underwent repeat examination and radiography at followup.

The first seven patients were treated by "traditional" pull-out suture and K-wire fixation, put into a cast for 4 weeks, and then gradually mobilized over 4 additional weeks. Thereafter, a "new method" was used. Avulsed ulnar collateral ligament stumps were sutured to the tendinous insertion of the adductor pollicis or to a soft tissue remnant using strong suture material. Large bony avulsions were pinned; small fragments were excised and the ligament was repaired. This latter method of repair was quite strong and allowed rapid mobilization: only 2 weeks in a cast, then a hand- mounted thumb spica orthosis was used while therapy progressed.

Of the patients treated with the new method, 84% had excellent results and, overall, were able to return to sports sooner than patients treated with the tradi tional method. Pain, stability, and strength were cor rected equally between groups; however, strength was restored more rapidly in the new method group. Range of motion was reduced equally in both groups.

Conclusion: Solid repair of complete ulnar collateral ligament avulsions, consisting of suturing the avulsed portion to the adductor pollicis insertion using strong suture material, combined with early hand therapy fa cilitated by the use of a removable hand-mounted thumb spica orthosis, is safe and allows a faster return to sports than the traditional method of repair.

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