Surgical Management of Thumb Ulnar Collateral Ligament Injuries: A Systematic Review and Meta-analysis of 614 Patients With a Minimum 1 Year Follow-up.

Abstract

Background: Thumb ulnar collateral ligament (UCL) injuries are relatively common and may lead to pain and instability. Outcomes following surgical management have generally been acceptable, but data comparing techniques are limited. Furthermore, the optimal timeframe for surgery has not been established. The purpose of this systematic review and meta-analysis was to compare outcomes of different surgical techniques and timeframes for treating thumb UCL injuries.

Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were analyzed based on the type of surgery performed: primary repair (PR) to soft tissue or bone tunnels, suture anchor repair (SAR) with or without internal brace, or reconstruction (REC) with autograft. A random effects model was used.

Results: The analysis included 24 studies with 616 thumbs (PR = 146, SAR = 371, REC = 99). Average follow-up was 47 months. Average time from injury to surgery was 9.3 days (PR), 4.1 months (SAR), and 19.1 months (REC). The most commonly stated indication for surgery was lack of a firm end point on collateral stress testing. In the reconstruction group, all injuries were described as chronic or irreparable. A notable difference was found in the proportion of stable thumbs (PR 95%, SAR 95%, REC 81%) and return to unrestricted activities (PR 96%, SAR 93%, REC 84%). No clinically notable differences were observed in pain, grip strength, pinch strength, QuickDASH scores, return to work, complications, or complications requiring intervention.

Conclusion: Surgical management of thumb UCL injuries produces overall favorable results. Acute, subacute, and repairable injuries treated with primary repair or suture anchor repair are more likely to be stable and allow unrestricted return to prior activities compared with chronic, irreparable injuries treated with reconstruction.