Skip to content

Patients › Hand

Pag-aayos ng UCL ng Hinlalaki

PDF Evidence Consent
Updated Oct 2026
Illustration: Pag-aayos ng UCL ng Hinlalaki

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Bakit iminungkahi ang operasyong ito

Si Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay itinutugma ang gamutan sa iyong partikular na pinsala. Ang ligament na apektado ay nasa panloob na gilid ng iyong hinlalaki, sa joint kung saan nagtatagpo ang hinlalaki at ang kamay. Kinukumpuni ng operasyong ito ang ligament na iyon upang maging stable muli ang joint.

Karaniwan naming sinisimulan sa non-operative care. Para sa partial tear, maaaring panatilihing hindi gumagalaw ng cast o splint ang hinlalaki habang ito ay gumagaling, at madalas itong nag-iiwan ng hinlalaking stable at walang sakit. Ngunit kapag lubusang napunit ang ligament, madalas ay hindi ito gumagaling nang kusa. Mga 75% ng mga complete tear ay hindi gumagaling sa pag-splint lamang. Maaari ring madulas palabas sa puwesto ang napunit na dulo ng ligament, na pumipigil dito na muling kumapit sa buto. Kung hindi magagamot ang ganitong punit, maaari itong magdulot ng pangmatagalang sakit at hirap sa paggamit ng iyong hinlalaki.

Maaaring irekomenda kaagad ang surgery para sa complete tear, o pagkatapos na hindi nagbigay ng sapat na pagbuti ang pag-splint. Ang layunin ay isang hinlalaking stable, walang sakit, at sapat ang lakas para sa paghawak nang mahigpit at pag-pinch. Ang sakit at paggana na iniulat ng mga pasyente ay bumubuti sa tatlo at 12 buwan pagkatapos ng repair kumpara sa bago ang operasyon.

Bago ang operasyon

Paplanuhin ng iyong surgeon ang operasyon gamit ang mga scan ng iyong hinlalaki. Karaniwan itong nagsisimula sa X-ray, na maaaring magpakita ng anumang maliit na bali kung saan humiwalay ang ligament. Maaari ring gumamit ng MRI o ultrasound scan upang ipakita ang mismong ligament at kumpirmahin kung dumulas palabas sa puwesto ang napunit na dulo.

Bago ang operasyon, bibigyan ka ng malinaw na mga instruksyon. Hindi ka dapat kumain sa loob ng pitong oras bago ang iyong operasyon. Pinapayagan nito na mailipat nang mas maaga ang iyong operasyon kung maagang matapos ang listahan sa theatre. Maaaring kailanganin mong itigil ang ilang gamot, at sasabihin sa iyo ng iyong surgeon kung alin at kailan. Magdala ng listahan ng lahat ng iyong iniinom. Mag-ayos ng isang taong maghahatid sa iyo pauwi pagkatapos, at magsuot ng maluwag at komportableng damit.

Kung mayroon kang iba pang kondisyong medikal, maaaring kailanganin mo ng mga blood test o review kasama ang anaesthetist.

Sa araw ng operasyon

Darating ka sa surgical admissions unit ng ospital, kung saan ka ire-rehistro at ihahanda para sa theatre. Makikilala mo roon ang anaesthetist. Ang operasyong ito ay ginagawa sa ilalim ng general anaesthetic. Minsan ay nagdaragdag ng regional nerve block para sa pagbawas ng sakit pagkatapos ng operasyon; tatalakayin ito ng anaesthetist sa iyo sa araw na iyon.

Pagkatapos ay dadalhin ka sa operating theatre, kung saan isasagawa ang operasyon. Pagkatapos nito, magigising ka sa recovery area, kung saan babantayan ka ng mga nurse habang nawawala ang bisa ng anaesthetic. Kapag stable ka na, maaaring pumunta ka sa ward o umuwi, depende sa procedure at sa iyong paggaling.

Ano ang kinapapalooban ng operasyon

Ang iyong surgeon ay gagawa ng maliit na hiwa sa gilid ng iyong hinlalaki kung saan humiwalay ang ligament. Sa pamamagitan ng hiwang ito, hinahanap nila ang napunit na dulo ng ligament at inihahanda ang isang maliit na bahagi sa buto kung saan ito dating nakakabit. Pagkatapos ay itinatahi pabalik ang ligament sa bahaging iyon gamit ang isang maliit na anchor na ibinabaon sa buto. Hinahawakan nito ang ligament sa puwesto habang ito ay gumagaling pabalik sa buto.

Kung matagal nang napunit ang ligament, maaaring masyado nang pudpod ang mga dulo upang tahiin nang magkasama. Sa ganoong kaso, maaaring muling buuin ng iyong surgeon ang ligament gamit ang isang kalapit na tendon mula sa sarili mong hinlalaki, na tinutupi upang bumuo ng bagong strap na kumokonekta sa buto sa magkabilang panig ng joint. Kung humiwalay ang ligament kasama ang isang maliit na piraso ng buto, ibinabalik sa puwesto ang fragment na iyon gamit ang isang maliit na plate at mga turnilyo.

Ang ilang repair ay pinatitibay gamit ang isang tape na parang laso na itinatahi sa tabi ng ligament. Ang tape na ito ay kumikilos na parang pansamantalang safety rope, na nakikihati sa bigat habang gumagaling ang ligament. Dahil sinasalo nito ang bahagi ng puwersa, maaaring makapagsimulang gumalaw ang iyong hinlalaki nang mas maaga kaysa sa repair lamang.

Maaari ring maglagay ang iyong surgeon ng maliit na metal na pin sa kabila ng joint ng hinlalaki upang panatilihin itong hindi gumagalaw at protektahan ang repair mula sa puwersang patagilid. Tinatanggal ang pin sa kalaunan, kapag umuusad na ang paggaling.

Isinasara ang hiwa gamit ang mga tahi at tinatakpan ng dressing. Pupunta ka sa recovery area, at titingnan ka ng nursing team habang nagkakamalay ka.

Pagkatapos ng operasyon

Magigising ka sa recovery area, pagkatapos ay ililipat ka sa ward. Ang iyong kamay ay nasa splint o cast, na may dressing sa ibabaw ng sugat. Pananatilihin kang komportable ng mga nurse at bibigyan ka ng gamot sa sakit kung kailangan mo. Maaari kang bumangon at gumalaw sa sandaling kaya mo na. Dapat may taong manatili sa iyo sa unang 24 oras sa bahay. Sasabihin sa iyo ng iyong team kung uuwi ka sa araw ring iyon o mananatili ng isang gabi sa ospital. Hahayaan naming nakalagay ang dressing sa loob ng humigit-kumulang 10 araw; pakiusap na huwag itong tatanggalin bago ang panahong iyon maliban kung sinabi namin sa iyo. Papalitan o tatanggalin namin ito kapag nakita ka na namin.

Paggaling

Magiging masakit at namamaga ang iyong hinlalaki sa mga unang araw at linggo. Unti-unti itong huhupa. Nakatutulong ang pagpapanatiling nakataas ng iyong kamay kapag nagpapahinga ka, gayundin ang gamot sa sakit na ibinibigay ng iyong team. Uuwi kang naka-splint o cast na nagpoprotekta sa repair habang ito ay gumagaling.

Mas malaki ang pagbabago sa iyong pang-araw-araw na gawain kaysa sa inaasahan mo. Kakailanganin mo ng tulong sa ilang gawain sa simula, lalo na sa anumang nangangailangan ng mahigpit na paghawak, tulad ng pagbubukas ng garapon o pagdadala ng mabibigat na bagay. Napapansin ng karamihan sa mga tao na kaya nilang gawin ang magagaang pang-araw-araw na gawain nang medyo maaga, at ang desk work sa loob ng mga saklaw na ipinapakita sa table sa pahinang ito. Mahalagang bahagi ng iyong paggaling ang hand therapy. Ang iyong hand therapist, si Ruby Doolan sa Extend Rehabilitation, ang gagabay sa iyong mga ehersisyo at gagawa ng anumang splint na kailangan mo habang gumagaling ang iyong hinlalaki. Nagsisimula nang banayad ang mga ehersisyo at unti-unting dinadagdagan habang lumalakas ang repair.

Habang humuhupa ang pamamaga at bumabalik ang paggalaw, nagiging mas madali ang mga pang-araw-araw na gawain. Kapag kuntento na ang iyong surgeon na gumaling na ang repair, unti-unti kang babalik sa mas mabigat na trabaho, sport at gym. Patuloy na bumubuti ang huling resulta sa loob ng ilang panahon, habang humuhupa ang sakit at bumabalik ang lakas.

Ang paggaling ay nag-iiba-iba sa bawat tao. Maaaring iba ang iyong timeline sa mga tipikal na saklaw, at gagabayan ka ng iyong surgeon at therapist sa bawat yugto.

Ano ang maaaring maging problema

Karamihan sa mga pasyente ay gumagaling nang maayos, ngunit paminsan-minsan ay maaaring magkaroon ng mga problema. Binabantayan kayo nang maigi ng inyong surgeon at ng team upang maagapan ang anumang isyu.

Ang sugat ay maaaring ma-infect. Maaari mong mapansin ang pamumula na kumakalat mula sa hiwa, likido o nana na lumalabas mula rito, o isang malalim at tumitibok na sakit na hindi nawawala sa simpleng painkiller. Tumawag sa clinic sa parehong araw kung mapansin mo ang alinman sa mga senyales na ito.

Minsan, ang isang maliit na nerve malapit sa hinlalaki ay naiirita habang nag-o-opera. Maaari itong magdulot ng pamamanhid, pangingilig o isang bahaging kakaiba ang pakiramdam sa likod ng hinlalaki. Inaasahan ang pamamanhid at panghihina sa unang 24 oras pagkatapos ng nerve block at humuhupa ang mga ito habang nawawala ang bisa ng block. Kung tumagal pa ang pamamanhid lampas doon, tumawag sa clinic.

Maaaring manatiling medyo maluwag o matigas ang joint. Napapansin ng ilang tao ang banayad na kirot sa base ng hinlalaki kapag nag-pi-pinch o humahawak nang mahigpit, o na hindi nakakatupi ang hinlalaki nang kasinglayo ng dati. Napapansin ng ilan na hindi na kasinlakas ng dati ang kanilang paghawak. Karaniwang banayad ang mga pagbabagong ito at madalas humuhupa sa paglipas ng panahon at sa tulong ng hand therapy. Banggitin ang mga ito sa iyong susunod na review kung nakakaabala ang mga ito sa iyo.

Maaaring mabigo ang repair mismo. Hindi ito karaniwan, ngunit ang pagkahulog o pagkakauntog ng hinlalaki sa mga unang linggo ay maaaring mag-unat o muling pumunit sa gumagaling na ligament. Makakaramdam ka ng biglaang sakit, pamamaga at pakiramdam na bumibigay ang hinlalaki. Tumawag sa clinic kung mangyari ito.

Kung gumamit ng metal na pin upang panatilihing hindi gumagalaw ang joint, maaaring mairita o ma-infect ang balat sa paligid nito. Ang pamumula, pananakit kapag hinawakan o likido sa paligid ng lugar ng pin ay dapat iulat sa clinic sa parehong araw.

Ang table ng mga komplikasyon sa pahinang ito ay naglilista ng mga tipikal na rate kung nais ninyo ang mga detalye.

Kailan dapat tumawag sa amin

Karamihan sa mga tao ay gumagaling nang walang problema, ngunit ang ilang senyales ay nangangailangan ng mabilis na atensyon.

Pumunta sa emergency department kung may pamamaga o sakit ka sa iyong binti (calf), o kinakapos ka ng hininga o may sakit sa dibdib. Maaaring senyales ang mga ito ng blood clot. Pumunta sa emergency department kung ang iyong hinlalaki, kamay o mga daliri ay namutla, lumamig, pumuti, naging kulay asul o nangitim.

Tumawag sa clinic sa parehong araw kung may lagnat ka, kumakalat na pamumula sa paligid ng sugat, o likido o nana na lumalabas mula rito. Tumawag sa clinic sa parehong araw kung patuloy na lumalala ang sakit sa kabila ng iyong mga gamot sa sakit.

Inaasahan ang pamamanhid at panghihina sa unang 24 oras pagkatapos ng nerve block at humuhupa ang mga ito habang nawawala ang bisa nito. Kung tumagal pa ang pamamanhid lampas doon, o hindi mo maigalaw ang iyong hinlalaki, kamay o mga daliri kapag nawala na ang bisa ng block, tumawag sa clinic.

Kung hindi mo makontak ang clinic, sa labas ng oras ng clinic o sa weekend, pumunta sa pinakamalapit na emergency department.

Reviewed by AI synthesis (v2) — pending human review · 21 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • A controlled active motion therapy protocol after suture anchor repair of a ruptured UCL of the thumb is safe from a biomechanical point of view [1].
  • Thumb UCL repair with suture tape augmentation demonstrates short-term outcomes comparable to what has been reported for other methods of repair [2].
  • In patients with chronic UCL reconstructions, there was no significant change in pinch strength [3].
  • In patients with chronic UCL reconstructions, significantly better results were achieved in grip strength, flexion, extension, ulnar and radial deviation [3].
  • Acute surgical repair of the torn ulnar collateral ligament can achieve good subjective and objective functional results [4].
  • Intraosseous suture anchor repair is a safe and effective method for repair of complete tears of the ulnar collateral ligament of the thumb MP joint [5].
  • Late reconstruction of the ulnar collateral ligament of the thumb MP joint with free tendon graft provided good improvement in stability and strength of the thumb [6].
  • Early mobilisation after robust tendon repairs is favoured to avoid tethering of the long tendons of the thumb during the early post-operative period [7].
  • In a surgical cohort of active-duty soldiers with thumb MCP UCL injuries, rifle-related injury was the most commonly documented injury mechanism [8].
  • Distal placement of the UCL phalangeal insertion restricted flexion motion from a mean of 57° to 47° [9].
  • Avulsion of the ulnar collateral ligament of the thumb IP joint is a previously undescribed injury [10].
  • At the last postoperative follow-up (range 6 weeks-6 months), 11 of 12 patients had good to excellent results subjectively and had regained 75% of the strength of the uninjured side [11].
  • Arthroscopic reduction of a Stener lesion allows healing of the ulnar collateral ligament without the need for open repair [12].
  • Functional and subjective outcomes were good or satisfactory in more than 90% of patients treated with functional bracing [13].
  • Pure ligamentous injuries of the ulnar collateral ligament of the thumb in a child are much less common than epiphyseal fractures [14].
  • Rodeo roping thumb injuries emphasize the importance of keeping the thumb upward and clear of the rope to avoid entrapment between the rope and saddle horn [15].
  • After undergoing open reduction and internal fixation for thumb ulnar collateral ligament avulsion fractures, patients had relief of thumb pain and pinch strength improved from 36% of the contralateral side to 89% (p < .01) [17].
  • The use of interference screws for fixation of tendon grafts to bone for hand ligament reconstructions is a promising new surgical technique [18].

Anatomy & Pathophysiology

Osseous Anatomy & Kinematics

  • The skeleton of the hand consists of 27 bones, of which 19 are long bones [32].
  • The thumb ray (first ray) is the shortest and consists of only three bones: a metacarpal and two phalanges [32].
  • The thumb metacarpal makes an angle of about 45 degrees with the second metacarpal in the sagittal plane [32].
  • The trapezium is angled out in front of the carpal plane, allowing the thumb metacarpal to oppose the other four digital rays [32].
  • The epiphyseal plates are located at the proximal ends of the phalanges and the first metacarpal [32].
  • The thumb metacarpal is independent and articulates with the trapezium [43].
  • The metacarpophalangeal joints are the keystones of the longitudinal arches of the hand [43].
  • The stability of the metacarpophalangeal joints is essential to the support of the longitudinal arch as well as the transverse metacarpal arch [43].
  • The thumb ray is more mobile, shorter, and more proximal than the other rays, allowing it to project in front of the plane of the palm [32].

Ligamentous & Soft Tissue Anatomy

  • The metacarpophalangeal joint is stabilized by collateral ligaments and by the thick volar articular capsule, known as the volar plate [43].
  • The lateral accessory ligaments, sagittal bands of the extensor apparatus, and the first annular segment of the flexor tendon pulley insert on the volar plate [43].
  • The sagittal band fibers insert onto the volar proximal phalanx and onto the lateral borders of the volar plate [31].
  • The sagittal bands form a sling that allows proximal extrinsic extensor tension to be transmitted to the proximal phalanx, permitting metacarpophalangeal joint extension without a tendinous insertion onto the proximal phalanx [31].
  • Rupture or attenuation of the sagittal band fibers allows the extrinsic extensor tendon to sublux to the ulnar side of the metacarpal head, causing ulnar deviation of the finger [31].
  • The flexor pollicis longus inserts into the proximal base of the thumb distal phalanx and is innervated by the anterior interosseous branch of the median nerve [47].
  • The flexor pollicis longus flexes both the interphalangeal and metacarpophalangeal joints of the thumb [47].
  • The tenosynovial sheath of the flexor pollicis longus is continuous with the radial bursa [47].
  • The princeps pollicis artery, a terminal branch of the radial artery, runs along the ulnar side of the first metacarpal bone and along the volar surface of the adductor muscle [44].
  • The princeps pollicis artery emerges onto the subcutaneous palmar tissue at the level of the cutaneous flexion crease of the metacarpophalangeal joint [44].
  • At the metacarpophalangeal joint level, the princeps pollicis artery divides into two terminal rami, the collateral palmar arteries of the thumb [44].
  • An arcade located deep in the flexor tendon joins together the two collateral palmar arteries at the level of the distal metaphysis of the first phalanx [44].
  • The dorsal arteries of the thumb originate from palmar arteries (princeps, commissural, or anastomoses of the superficial arcade) at the level of the first metacarpal [44].
  • The ulnar dorso-collateral artery generally stems from the princeps pollicis onto the medial border of the neck of the first metacarpal [44].

Pathophysiology & Injury Mechanisms

  • Acute injuries to the thumb ulnar collateral ligament (UCL) of the metacarpophalangeal joint are the result of a sudden, significant radial force causing abduction of the thumb [20].
  • Fractures can occur at the base of the proximal phalanx in association with ruptures of the UCL of the metacarpophalangeal joint [19].
  • Proximal phalanx base fractures associated with UCL rupture are caused either by avulsion of the UCL from its insertion or by shearing of the base by the palmar portion of the radial condyle [19].
  • In sheared fractures, the fragment does not contain the UCL insertion, and its position is unrelated to the location of the insertion of the UCL [19].
  • In avulsion fractures, the position of the bone fragment indicates the location of the end of the ligament [19].
  • A displaced ligament (Stener lesion) can occur in the presence of a nondisplaced fracture [19].
  • The mechanism of fracture (avulsion vs. shear) cannot be determined by radiographic appearance and is revealed only at surgery by inspecting the bone and its relationship to the end of the ligament [19].
  • Supination and flexion of the thumb provided less stability when both components of the UCL were sectioned [20].
  • Pronation and supination play a role in the stability of the thumb metacarpophalangeal joint [20].
  • Performing a physical examination to assess instability did not create a Stener lesion if the exam was performed in a controlled, gentle manner with the thumb held without rotation [20].
  • A Stener lesion was possible to create during examination only when the thumb was tested in a flexed and supinated position and there was sectioning of the proximal UCL, accessory UCL, and the origin of the ulnar sagittal band at the adductor aponeurosis [20].
  • Pure ligamentous injuries of the UCL of the thumb in a child are much less common than epiphyseal fractures [14].
  • Traumatic avulsion of the ulnar collateral ligament of the interphalangeal joint of the thumb is a previously undescribed injury [10].
  • In a surgical cohort of active-duty soldiers with thumb metacarpophalangeal UCL injuries, rifle-related injury was the most commonly documented injury mechanism [8].

Classification

  • Acute injuries of the thumb ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint are the result of a sudden, significant radial force causing abduction of the thumb [20].
  • Fractures can occur at the base of the proximal phalanx in association with ruptures of the UCL of the MCP joint of the thumb [19].
  • Proximal phalanx base fractures associated with UCL rupture are either caused by an avulsion of the UCL from its insertion on the proximal phalanx or by the shearing of the base of the proximal phalanx by the palmar portion of the radial condyle with continued displacement after UCL rupture [19].
  • A sheared fragment of the proximal phalanx base does not contain the UCL insertion [19].
  • If a fragment of bone has been avulsed by the UCL, its position indicates the location of the end of the ligament [19].
  • A radiograph can reveal whether the insertion of the ligament is displaced, indicating a Stener lesion [19].
  • A displaced ligament can occur in the presence of a nondisplaced fracture [19].
  • The mechanism of fracture cannot be determined by radiographic appearance alone [19].
  • The mechanism of fracture is revealed only at surgery by inspecting the bone and its relationship to the end of the ligament [19].
  • Pure ligamentous injuries of the ulnar collateral ligament of the thumb in a child do occur, but they are much less common than epiphyseal fractures [14].
  • Traumatic avulsion of the ulnar collateral ligament of the interphalangeal (IP) joint of the thumb is a previously undescribed injury [10].

Clinical Presentation

Injury Mechanisms and Epidemiology

  • Acute thumb UCL injuries are the result of a sudden, significant radial force causing abduction of the thumb [20].

Physical Examination and Diagnostic Findings

  • Performing a physical examination to assess the amount of instability of an ulnar collateral ligament injury did not create a Stener lesion if the exam was performed in a controlled, gentle manner with the thumb held without rotation [20].
  • It was possible to create a Stener lesion during physical examination when the thumb was tested in a flexed and supinated position, but only if there was sectioning of the pUCL, the aUCL, and the origin of the ulnar sagittal band at the adductor aponeurosis [20].
  • Thumbs with a stress angle difference of 15° should always be explored for a probable Stener lesion [34].
  • Diagnostic ultrasound is a useful, noninvasive tool for assessing the extent of rupture of the ulnar collateral ligament [25].

Radiographic and Anatomical Considerations

  • These fractures are either caused by an avulsion of the UCL from its insertion on the proximal phalanx or by the shearing of the base of the proximal phalanx by the palmar portion of the radial condyle with continued displacement after UCL rupture [19].
  • A radiograph can reveal whether the insertion of the ligament is displaced (Stener lesion) if a fragment of bone has been avulsed by the UCL [19].
  • If a fragment has been sheared, its position is unrelated to the location of the insertion of the UCL [19].
  • The mechanism of fracture cannot be determined by radiographic appearance and is revealed only at surgery by inspecting the bone and its relationship to the end of the ligament [19].

Investigations

  • Fluoroscopy, MRI and ultrasound are increasingly being used and evaluated as diagnostic tools for thumb UCL injuries [20].
  • If a fragment of bone has been sheared rather than avulsed, its position is unrelated to the location of the insertion of the UCL [19].
  • It was possible to create a Stener lesion when the thumb was tested in a flexed and supinated position, but only if there was sectioning of the pUCL, the aUCL, and the origin of the ulnar sagittal band at the adductor aponeurosis [20].

Treatment

Operative Repair Techniques

  • Suture anchor and suture tape augmentation techniques preserve native ligament proprioception while providing additional stability during early healing phases [28].
  • At the last postoperative follow-up (range 6 weeks-6 months), 11 of 12 patients treated with an alternative collateral ligament repair method had good to excellent results subjectively and had regained 75% of the strength of the uninjured side [11].
  • Both steel wire and simple suture techniques for UCL repair were equally effective, with the steel wire offering no clinical advantage over simple suture [33].
  • A novel technique of thumb collateral ligament reconstruction in acute injuries resulted in negative instability tests and satisfying results in terms of motion (ROM loss less than 20%) and grip strength (loss less than 17%) at 3-month follow-up [36].
  • In a comparison of acute and chronic UCL injuries, there were no statistically significant differences between operated and contralateral healthy thumb MCP joints in flexion, extension, ulnar deviation, radial deviation, grip strength, or tip pinch strength at final follow-up [27].
  • In the avulsion fracture group of a comparative study, reduction was successful and union was observed with no complications such as reduction loss, MCP osteoarthritis, bone necrosis, or non-union [27].
  • Ulnar deviation and radial deviation were significantly better in the avulsion group than in the rupture group [27].
  • Grip and tip pinch strengths were significantly better in the avulsion group than in the rupture group [27].

Reconstruction Techniques

  • Late reconstruction of the ulnar collateral ligament of the thumb MP joint with a free tendon graft provided good improvement in stability and strength of the thumb [6].

Post-operative Management and Rehabilitation

  • Early mobilization after robust tendon repairs is favored to avoid tethering of the long tendons of the thumb during the early post-operative period [7].
  • Immobilization of the MCP joint with a K-wire after surgical repair of the UCL allows return to work within 7 days for 62% of patients who are not manual workers [21].
  • In patients with chronic UCL reconstructions, there was no significant change in pinch strength, but significantly better results were achieved in grip strength, flexion, extension, ulnar and radial deviation [3].

Non-Operative Management

Surgical Considerations and Complications

  • Immediate repair of ruptured structures at both joints in a case of traumatic avulsion of the UCL of the IP joint and MCP joint produced a satisfactory result [16].
  • Fractures at the base of the proximal phalanx associated with UCL ruptures can be caused by avulsion of the UCL or by shearing of the base by the palmar portion of the radial condyle [19].
  • A displaced ligament (Stener lesion) can occur in the presence of a nondisplaced fracture if the fragment was sheared rather than avulsed [19].
  • The mechanism of fracture (avulsion vs. shearing) cannot be determined by radiographic appearance and is revealed only at surgery by inspecting the bone and its relationship to the end of the ligament [19].

Complications

  • In a cohort of 12 patients treated with an alternative repair method, 11 had good to excellent subjective results and regained 75% of the strength of the uninjured side at follow-up ranging from 6 weeks to 6 months [11].
  • After open reduction and internal fixation for thumb ulnar collateral ligament avulsion fractures, pinch strength improved from 36% of the contralateral side to 89% (p < .01) [17].
  • In a comparison of acute and chronic UCL injuries, no complications such as reduction loss, MCP osteoarthritis, bone necrosis, and non-union were observed in the avulsion fracture group [27].
  • In a comparison of acute and chronic UCL injuries, four patients in the avulsion group and four patients in the rupture group experienced mild intermittent pain caused by light activity [27].

Recovery

  • Early active mobilization following UCL repair with a Mitek bone anchor leads to an earlier return to full hand function at 6 weeks compared to 8 weeks [29].
  • Early active mobilization following UCL repair with a Mitek bone anchor leads to an earlier return to work at 7 weeks compared to 11 weeks [29].
  • A policy of early mobilisation after robust tendon repairs is favoured to avoid tethering of the long tendons of the thumb during the early post-operative period [7].

Key Evidence

  • [L5] A controlled active motion therapy protocol after suture anchor repair of a ruptured UCL of the thumb is safe from a biomechanical point of view. [1] (10.1016/j.jhsa.2004.04.017)
  • [L4] Thumb UCL repair with suture tape augmentation demonstrates short-term outcomes comparable to what has been reported for other methods of repair. [2] (10.1142/s2424835520500046)
  • [L3] There was no significant change in pinch strength in patients with chronic UCL reconstructions, but significantly better results were achieved in grip strength, flexion, extension, ulnar and radial deviation. [3] (10.1016/j.hansur.2020.03.002)
  • [L4] Acute surgical repair of the torn ulnar collateral ligament can achieve good subjective and objective functional results. [4] (10.1016/0020-1383(94)90179-1)
  • [L3] The authors concluded that this is a safe and effective method for repair of complete tears of the ulnar collateral ligament of the thumb MP joint. [5] (10.1016/s0363-5023(97)80113-x)
  • [L1] This new technique provided good improvement in stability and strength of the thumb. [6] (10.1016/s0363-5023(03)80385-4)
  • [L4] In this field of tendon surgery, we favour a policy of early mobilisation after robust tendon repairs to avoid tethering of the long tendons of the thumb during the early post-operative period. [7] (10.1197/j.jht.2005.01.008)
  • [L4] In this surgical cohort of active-duty soldiers with thumb MCP UCL injuries, rifle-related injury was the most commonly documented injury mechanisms. [8] (10.1016/j.injury.2026.113711)
  • [L5] Distal placement of the UCL phalangeal insertion restricted flexion motion (from a mean of 57° to 47°). [9] (10.1053/jhsu.1999.0283)
  • [L5] We present a previously undescribed injury of avulsion of the ulnar collateral ligament of the thumb IP joint. [10] (10.1016/s0266-7681(05)80061-0)
  • [L4] At the last postoperative follow-up (range 6 weeks-6 months) 11 of 12 patients had good to excellent results subjectively and had regained 75% of the strength of the uninjured side. [11] (10.1016/s0266-7681(97)80436-6)
  • [L4] Results indicate that arthroscopic reduction of a Stener lesion allows healing of the ulnar collateral ligament without the need for open repair. [12] (10.1016/s0363-5023(05)80156-x)
  • [L2] Functional and subjective outcomes were good or satisfactory in more than 90% of patients. [13] (10.1016/s0363-5023(89)80026-7)
  • [L5] Pure ligamentous injuries of the ulnar collateral ligament of the thumb in a child do occur, but they are much less common than epiphyseal fractures. [14] (10.1016/s0363-5023(86)80009-0)
  • [L4] These injuries emphasize the importance of keeping the thumb upward and clear of the rope to avoid entrapment between the rope and saddle horn. [15] (10.1016/s0363-5023(84)80136-7)
  • [L5] Immediate repair of the ruptured structures at both joints produced a satisfactory result. [16] (10.1016/s0363-5023(87)80224-1)
  • [L4] After undergoing open reduction and internal fixation, the patients had relief of thumb pain and pinch strength improved from 36% of the contralateral side to 89% (p < .01). [17] (10.1016/s0363-5023(97)80049-4)
  • [L5] The use of interference screws for fixation of tendon grafts to bone for hand ligament reconstructions is a promising new surgical technique. [18] (10.1016/j.jhsa.2004.12.013)
  • [L5] [19] (10.1016/s0363-5023(98)80158-5)
  • [L5] [20] (10.1142/s0218810417500411)
  • [L4] Immobilization of the MCP joint with a K-wire after surgical repair of the UCL is an option that allows return to work within 7 days for 62% of patients who are not manual workers. [21] (10.1016/j.hansur.2015.12.007)
  • [L5] Diagnostic ultrasound is a useful, noninvasive tool for assessing the extent of rupture of the ulnar collateral ligament. [25] (10.1016/0363-5023(94)90025-6)
  • [L4] [27] (10.1016/j.main.2014.10.003)
  • [L5] The technique preserves native ligament proprioception while providing additional stability during early healing phases. [28] (10.1016/j.eats.2025.103957)
  • [L1] Our results show that on average early active mobilization leads to an earlier return to full hand function (6 vs. 8 wk) and an earlier return to work (7 vs. 11 wk). [29] (10.1097/bth.0b013e318284dbd7)
  • [L4] Both techniques were equally effective, and the use of the more expensive steel wire, while technically satisfying and easy to perform, offers no clinical advantage over simple suture. [33] (10.1016/0266-7681(92)90079-h)
  • [L4] Our study shows that thumbs with a stress angle difference of 15° should always be explored for a probable Stener lesion. [34] (10.1177/1753193412455789)
  • [L5] At 3 month follow up, tests for instability were negative and satisfying results in terms of motion (ROM loss less than 20%), grip strength (loss less than 17%) were observed. [36] (10.1016/j.jhse.2007.04.010)

References

[1] A biomechanical modeling of injury, repair, and rehabilitation of ulnar collateral ligament injuries of the thumb. The Journal of Hand Surgery. 2004. DOI: 10.1016/j.jhsa.2004.04.017

[2] Thumb Ulnar Collateral Ligament Repair with Suture Tape Augmentation. The Journal of Hand Surgery (Asian-Pacific Volume). 2020. DOI: 10.1142/s2424835520500046

[3] The effects of rehabilitation on the outcomes of surgically treated acute and chronic thumb metacarpophalangeal ulnar collateral ligament ruptures. Hand Surgery and Rehabilitation. 2020. DOI: 10.1016/j.hansur.2020.03.002

[4] Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Injury. 1994. DOI: 10.1016/0020-1383(94)90179-1

[5] Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with an intraosseous suture anchor. The Journal of Hand Surgery. 1997. DOI: 10.1016/s0363-5023(97)80113-x

[6] Late reconstruction of the ulnar collateral ligament of the thumb MP joint with free tendon graft — A new technique. The Journal of Hand Surgery. 2003. DOI: 10.1016/s0363-5023(03)80385-4

[7] New Concepts in Managing the Long Tendons of the Thumb After Primary Repair. Journal of Hand Therapy. 2005. DOI: 10.1197/j.jht.2005.01.008

[8] Return to Duty After Suture Anchor Repair of Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries in Active Duty Soldiers. Injury. 2026. DOI: 10.1016/j.injury.2026.113711

[9] The effect of thumb metacarpophalangeal ulnar collateral ligament attachment site on joint range of motion: An in vitro study. The Journal of Hand Surgery. 1999. DOI: 10.1053/jhsu.1999.0283

[10] Traumatic Avulsion of the Ulnar Collateral Ligament of the IP Joint of the Thumb. Journal of Hand Surgery. 1995. DOI: 10.1016/s0266-7681(05)80061-0

[11] Alternative Method of Repairing Collateral Ligament Injuries at the Metacarpophalangeal Joints of the Thumb and Fingers. Journal of Hand Surgery. 1997. DOI: 10.1016/s0266-7681(97)80436-6

[12] Arthroscopic treatment of acute complete thumb metacarpophalangeal ulnar collateral ligament tears. The Journal of Hand Surgery. 1995. DOI: 10.1016/s0363-5023(05)80156-x

[13] Gamekeepers thumb: A prospective study of functional bracing. The Journal of Hand Surgery. 1989. DOI: 10.1016/s0363-5023(89)80026-7

[14] Ligamentous avulsion of the ulnar collateral ligament of the thumb of a child. The Journal of Hand Surgery. 1986. DOI: 10.1016/s0363-5023(86)80009-0

[15] Rodeo roping thumb injuries. The Journal of Hand Surgery. 1984. DOI: 10.1016/s0363-5023(84)80136-7

[16] An unusual variety of skier's thumb. The Journal of Hand Surgery. 1987. DOI: 10.1016/s0363-5023(87)80224-1

[17] Failure of cast immobilization for thumb ulnar collateral ligament avulsion fractures. The Journal of Hand Surgery. 1997. DOI: 10.1016/s0363-5023(97)80049-4

[18] Fixation of Tendon Grafts for Collateral Ligament Reconstructions: A Cadaveric Biomechanical Study. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2004.12.013

[19] The stener lesion revisited: A case report. The Journal of Hand Surgery. 1998. DOI: 10.1016/s0363-5023(98)80158-5

[20] Can Physical Examination Create a Stener Lesion?. The Journal of Hand Surgery (Asian-Pacific Volume). 2017. DOI: 10.1142/s0218810417500411

[21] Duration of sick leave after surgical repair of the ulnar collateral ligament of the thumb metacarpophalangeal joint with K-wire immobilization: Prospective case series of 21 patients. Hand Surgery and Rehabilitation. 2016. DOI: 10.1016/j.hansur.2015.12.007

[25] Ultrasonographic detection of thumb ulnar collateral ligament injuries: A cadaveric study. The Journal of Hand Surgery. 1994. DOI: 10.1016/0363-5023(94)90025-6

[27] Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Chirurgie de la Main. 2014. DOI: 10.1016/j.main.2014.10.003

[28] Thumb Ulnar Collateral Ligament Repair Using Suture Anchors and Suture Tape Augmentation. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103957

[29] Early Active Mobilization Following UCL Repair With Mitek Bone Anchor. Techniques in Hand & Upper Extremity Surgery. 2013. DOI: 10.1097/bth.0b013e318284dbd7

[31] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > Image DISORDERS OF THE MUSCULATURE OF THE HAND.

[32] Exam Of The Hand Wrist 2Ed. 1.1 SKELETON OF THE HAND > The osseous skeleton.

[33] Ulnar Collateral Ligament Repair of the Metacarpo-Phalangeal Joint of the Thumb: A Study Comparing Two Methods of Repair. Journal of Hand Surgery. 1992. DOI: 10.1016/0266-7681(92)90079-h

[34] Re-evaluation of stress radiographic findings for preoperative diagnosis of Stener lesion. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412455789

[36] A Novel Technique of Thumb Collateral Ligament Reconstruction in Acute Injuries. Journal of Hand Surgery (European Volume). 2007. DOI: 10.1016/j.jhse.2007.04.010

[43] Exam Of The Hand Wrist 2Ed. The arches of the hand > The metacarpal arch.

[44] Exam Of The Hand Wrist 2Ed. Techniques of investigation of the arterial supply by J P Melki > Vascularization of the thumb > Palmar aspect.

[47] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > FLEXOR TENDON INJURY.

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.