Ulnar Collateral Ligament Repair of the Thumb with a Transosseous Suture Technique - A Retrospective Analysis

Background: This study analyses the outcome of a transosseous suture fixation for the ulnar collateral ligament (UCL) of the thumb, which is performed completely internally. Methods: 60 patients with distal rupture of the UCL of the thumb were surgically treated with a transosseous suture technique. Patients with ligament tears surgically treated within 14 days after injury were included in Group 1 (n = 33); patients with delayed surgical treatment (> 14 days after injury) in Group 2 (n = 13). Group 3 (n = 14) contained patients with avulsion fractures. Subjective, functional, and radiological outcomes were evaluated after at least 24 months, and up to an average of 68 months after surgery. Statistical analysis was performed using the Kruskal-Wallis test, Mann-Whitney test, chi-square test, and Wilcoxon test. Results: No significant differences were seen for the disability of the arm, shoulder and hand (DASH) scores among the groups. The average DASH score was 2.4 +/- 3 points in Group 1, 4.6 +/- 9 points in Group 2 and 5 +/- 8 points in Group 3. The visual and verbal pain analogue scales showed significant differences between Groups 1 and 2 at (p = 0.02) and after exertion (p = 0.03). Significant differences were seen for the flexion of the interphalangeal joint in Group 1 (p = 0.004) and the radial abduction of the thumb in Group 3 (p = 0.001), as compared to the contralateral hand. Furthermore, significant differences were obtained for the pinch strength between the thumb and the ring finger in Group 1 (p = 0.03) and 3 (p = 0.04), as well as pinch (p = 0.02) and key strength (p = 0.03) of the little finger in Group 1, again compared to the contralateral hand. Group 3 (p < 0.001) showed significantly more radiological bony alterations at the distal UCL insertion than the other groups. Conclusions: This study shows good to very good subjective, functional, and radiological results in all three groups. Therefore, we recommend this transosseous suture fixation as an affordable, practicable technique for the treatment of acute rupture of the UCL of the thumb with and without avulsion fractures.