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Thumb UCL Repair

48 citationsUpdated Sep 2026

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Overview

Untreated ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal joint can lead to long-term pain and functional limitations [5]. Consequently, surgical management of thumb UCL injuries produces overall favorable results [1]. The rate of surgery for acute thumb MP UCL injury varies based on patient characteristics and the individual treating surgeon [6]. Conservative management with a custom-made hinged splint shows promise for compliant patients with Grade III complete ruptures [7]; however, 75% of cases with complete rupture of the ulnar collateral ligament of the thumb will fail to heal with conservative treatment [2].

Primary suture anchor repair without ligament reconstruction appears to be a safe and effective treatment option for patients' thumb UCL injuries, even in the chronic setting [8]. Both pull-out sutures and bone anchor techniques are safe and effective for treating thumb ulnar collateral ligament injuries [14]. The use of suture anchor repair with suture tape augmentation for thumb UCL injuries is a treatment option that allows for early range of motion with satisfactory early outcomes that are comparable to intraosseous suture anchor repair [33].

Patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline [3]. Return-to-play rates after surgical treatment of thumb UCL injuries are high, with reassuring return to preinjury level of play with few complications [12]. Players who underwent thumb UCL repair played in a similar number of games per season and had similar career lengths in the MLB as controls [4].

Anatomy & Pathophysiology

Ligamentous

Sequential tearing of the thumb UCL leads to progressive instability of the MCP joint [11]. No static ligament reconstruction restores the normal stability characteristics of the thumb UCL [9]. Biomechanically, there are no treatments of repair or reconstruction using native tissues that provide equivalent strength to the preinjured ligament [35].

Repair vs. Reconstruction: * Single- and double-bundle UCL reconstructions: These have comparable biomechanical properties in regard to joint congruity under valgus load [37]. * ST vs. SA constructs: Although both recapitulate native joint stiffness, repair with ST demonstrated the greatest biomechanical strength in stiffness and load-to-failure [41]. * Tunnel positioning: A triangular configuration with apex proximal stabilizes the thumb MCP joint while maintaining flexion/extension range of motion [39].

Kinematics

Variations in thumb MCP joint rotation during stress testing may influence clinical interpretation, and standardization of testing with the thumb MCP joint in neutral rotation is recommended [42]. Osseous morphology dictates motion patterns: in flat MCP joints, the RA is more dorsal and distal in the metacarpal head compared to round joints, resulting in a hinged flexion motion [43].

Restoration of ROM and Stability: * Round joints: Only the non-anatomic Glickel procedure restores normal ROM and stability [50]. * Flat joints: The Glickel procedure and a modified Fairhurst configuration with origins dorsal in the metacarpal head restore ROM and stability [50].

Classification

Three-Tier System: Grade I injury is defined as minor tearing without instability [19]. Grade II injury is a partial ligament tear with increased joint laxity but a definitive end point on clinical testing [19]. Grade III injury is a complete ligament tear and gross instability on examination [19] [19].

Five-Stage Grading System: This system separates thumb UCL injuries into operative and non-operative groups when no fracture is present [32].

Four-Stage Treatment-Oriented Classification: This classification is based on the degree of UCL displacement and correlates with the likelihood of success with immobilization or operative intervention [21].

Radiographic Findings: The displaced fleck sign is a radiographic finding consistent with Grade III thumb UCL tears with Stener lesions [19]. It appears as a small avulsion fracture of the UCL insertion from the proximal phalanx base that has displaced proximally and ulnarly [19].

MRI Evaluation: MRI evaluation reveals greater details enabling better understanding and management of thumb UCL injuries [20]. A normal UCL appears as a low-signal-intensity band medial to the MCP joint with the distal attachment over the base of the proximal phalanx [32]. A UCL rupture without displacement depicts a discontinuous distal end of the UCL with intermediate signal intensity remaining in the normal position [32]. A displaced UCL appears retracted or folded onto itself proximally [32].

Ultrasound Imaging: Ultrasound imaging can show a torn and proximal Stener lesion with a thickened adductor aponeurosis [32]. It can also show a thickened and injured adductor aponeurosis with an intact UCL [32].

Other Considerations: Nonsurgical treatment is indicated for Grade I or II tears of the UCL or RCL [15]. Nonsurgical treatment is indicated for Grade III UCL tears without a Stener lesion [15]. Surgical treatment is indicated for Grade III UCL tears with a Stener lesion [15]. Surgical treatment is indicated for Grade III RCL tears [15]. Surgical treatment is indicated for Grade III UCL tears without a Stener lesion [15]. Partial (Grade I or II) ligament tears are contraindications for surgical repair [15]. Chronic tears with associated osteoarthritis are contraindications for surgical repair [15].

Clinical Presentation

Thumb ulnar collateral ligament (UCL) injuries are common, accounting for approximately 50 presentations per 100,000 Emergency Department visits in the United Kingdom [29]. Acute injuries most frequently occur during sports via a radially-directed force at the joint [19]. Patients typically present with pain and dysfunction [29]. Untreated UCL injuries of the thumb metacarpophalangeal (MCP) joint can lead to long-term pain and functional limitations [5].

Grading and Classification: * Grade I: Minor tearing without instability [19]. * Grade II: Partial ligament tears with increased joint laxity but a definitive end point on clinical testing [19]. * Grade III: Complete ligament tears with gross instability on examination [19]. * Stener Lesion: A specific displacement pattern associated with Grade III tears [19]. * 4-Stage Classification: A treatment-oriented system based on the degree of UCL displacement, correlating with the likelihood of success with immobilization versus operative intervention [21].

Clinical Examination: Examination of the MCP joint involves applying a radial force in extension and with approximately 30° of MCPJ flexion to relax the palmar plate [29]. UCL laxity is defined by no firm endpoint, >20 degrees laxity compared to the other side, or >30 degrees laxity [27]. Comparison with the uninjured contralateral thumb is unreliable in many individuals due to significant variation between right and left thumbs [28]. Fluoroscopic stress testing demonstrates right-left differences and discrepancies between clinical and fluoroscopic findings, which practitioners must consider when making treatment decisions [26].

Imaging Adjuncts: * Ultrasonography: Has evolved as a reliable adjunct to clinical examination in the evaluation of the thumb UCL [18]. * MRI: Reveals greater details enabling better understanding and management of UCL injuries of the thumb MCP joint [20].

Management Indications: Grade I and II injuries are generally treated nonoperatively with immobilization [19]. Grade III UCL tears with a Stener lesion are treated with surgical repair or reconstruction [19]. Grade III radial collateral ligament (RCL) tears are also treated with surgical repair or reconstruction [15]. Partial (Grade I or II) ligament tears are contraindications for surgery [15]. Chronic tears with associated osteoarthritis are contraindications for surgery; symptomatic patients are best managed with thumb MCP joint arthrodesis [15].

Outcomes: Complications of operation are rare, and most patients show preservation of motion, key pinch, and grip strength [22]. The functional results of operative treatment are excellent, resulting in a stable and painless thumb in the vast majority of cases [23].

Investigations

Plain radiography: Clinical assessment of thumb UCL injury should be supplemented with radiographs because underlying pathology, such as an enchondroma, may be a factor [56]. Fluoroscopy-assisted stress testing demonstrates right-left differences and differences between clinical and fluoroscopic testing that practitioners should be aware of when making treatment decisions [26].

Ultrasonography: Ultrasonography is a reliable adjunct to clinical examination in the evaluation of the thumb UCL [18]. However, it is not adequate for identifying dislocated ulnar collateral ligaments of the thumb MCP joint [54].

Other Considerations: Grade I thumb UCL injuries are defined as minor tearing without instability [19]. Grade II thumb UCL injuries are defined as partial ligament tears with increased joint laxity but a definitive end point on clinical testing [19]. Grade III thumb UCL injuries are defined as complete ligament tears with gross instability on examination [19]. Sequential tearing of the thumb UCL leads to progressive instability of the metacarpophalangeal (MCP) joint [11].

Treatment

Non-Operative

Nonsurgical management is indicated for Grade I or II tears of the UCL or RCL, as well as Grade III UCL tears that do not present with a Stener lesion [15].

Operative

Indications: Surgical management is indicated for Grade III UCL tears with a Stener lesion, Grade III RCL tears, and Grade III UCL tears without a Stener lesion [15]. Surgical repair of acute UCL ruptures is widely accepted as the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures [36]. Chronic tears with associated osteoarthritis are contraindications for surgical repair; symptomatic patients are best managed with a thumb MCP joint arthrodesis [15].

Surgical Approach / Technique: Thumb UCL reconstruction using a tendon autograft improves patient-reported outcomes, including pain and function [13]. Nonbiological ligament reconstruction of the thumb ulnar collateral ligament generates short-term outcomes comparable with those of biological ligament reconstruction (BLR), potentially allowing for expedited recovery and rehabilitation [44]. Thumb UCL repair with suture tape augmentation demonstrates greater maximum and clinical failure loads compared with nonaugmented repair at time 0, without any biological healing [16]. This augmentation is able to restore varus/valgus kinematics after complete UCL tear without over-constraining the joint [53]. Implementation of an accelerated rehabilitation protocol following thumb UCL augmentation with suture tape allows individuals to successfully return to unrestricted work, activity, and sports by 5-6 weeks post-surgery [57].

Implant Selection: Mini hook plate fixation for thumb ulnar collateral ligament avulsion fracture allowed early postoperative rehabilitation and provided stability of the thumb MP joint and excellent clinical outcomes [10]. The hook plate construct was biomechanically superior to the suture anchor construct for fixation of thumb metacarpophalangeal joint UCL fracture-avulsions with regard to load to failure [51]. All UCL reconstructions in a cadaveric osteolysis model failed by fracture: 8/11 at the proximal phalanx and 3/11 at the metacarpal [17].

Complications

Conservative Management Failure: Conservative treatment fails to heal 75% of cases with complete rupture of the ulnar collateral ligament of the thumb [2]. Untreated ulnar collateral ligament injury of the thumb metacarpophalangeal joint can lead to long-term pain and functional limitations [5].

Post-Reconstruction Outcomes: Complications are rare and most patients show preservation of motion, key pinch, and grip strength [22]. Mean loss of motion was 20% at the MCP joint in patients treated with reverse apex configuration free tendon graft reconstruction [45]. Fourteen thumbs had slightly reduced flexion at both the metacarpophalangeal and interphalangeal joints after reconstruction [46]. Five patients had reduced power grip after reconstruction [46].

Persistent Pain: One patient experienced persistent aching of the metacarpophalangeal joint when pinching after reconstruction [46]. Five patients experienced persistent aching of the metacarpophalangeal joint when pinching, though it was mild and not disabling [46].

Recurrent Injury and Secondary Procedures: One patient suffered a further injury and rupture of a simple ligament plication performed more than 8 weeks post-injury [46]. One patient had a joint fusion after the extensor pollicis brevis reconstruction failed to resolve pain [46].

Nerve Injury: Damage to a branch of the superficial radial nerve resulted in a painful neuroma on the dorso-ulna aspect of the thumb in one patient [46].

Other Considerations: All UCL reconstructions in a cadaveric osteolysis model failed by fracture, with 8/11 failing at the proximal phalanx and 3/11 at the metacarpal [17].

Recovery

Light activity (weeks): Accelerated rehabilitation protocols are utilized in athletes following thumb MCP UCL repair to facilitate early mobilization [25].

Full activity (months): Return-to-play rates after surgical treatment of thumb UCL injuries are high [12]. Surgical treatment results in a reassuring return to preinjury level of play with few complications [12]. Collegiate football athletes treated with suture anchor repair demonstrate quick return to play [55]. There is a high rate of return to sport in the NFL following thumb UCL surgery [31].

Complete recovery / outcome plateau (months): Patient-reported outcomes improve significantly at three months after open surgical repair of the thumb UCL compared to baseline [3]. Patient-reported outcomes improve significantly at 12 months after open surgical repair of the thumb UCL compared to baseline [3].

Rehabilitation protocol: Mini hook plate fixation for thumb ulnar collateral ligament avulsion fracture allowed early postoperative rehabilitation [10].

Functional milestones: Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft [13]. Collegiate football athletes treated with suture anchor repair had reliable return to the same level of activity [55]. Collegiate football athletes treated with suture anchor repair had excellent long-term clinical outcomes [55].

Other Considerations: Primary suture anchor repair without ligament reconstruction appears to be a safe and effective treatment option for patients' thumb UCL injuries in the chronic setting [8]. Mini hook plate fixation for thumb ulnar collateral ligament avulsion fracture provided stability of the thumb MP joint [10]. Mini hook plate fixation for thumb ulnar collateral ligament avulsion fracture provided excellent clinical outcomes [10]. Players who underwent thumb UCL repair played in a similar number of games per season as controls [4]. Players who underwent thumb UCL repair had similar career lengths in the MLB as controls [4].

Key Evidence

  • [L1] Surgical management of thumb UCL injuries produces overall favorable results. [1] (10.5435/jaaosglobal-d-25-00082)
  • [L5] 75% of cases with complete rupture of the ulnar collateral ligament of the thumb will fail to heal with conservative treatment. [2] (10.1007/s11552-008-9145-8)
  • [L2] Patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline. [3] (10.1016/j.jhsa.2023.05.003)
  • [L3] Players who underwent thumb UCL repair played in a similar number of games per season and had similar career lengths in the MLB as controls. [4] (10.1177/2325967117747268)
  • [L5] Untreated ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal joint can lead to long-term pain and functional limitations. [5] (10.2106/jbjs.k.01024)
  • [L3] The rate of surgery for acute thumb MP UCL injury varies based on patient characteristics and the individual treating surgeon. [6] (10.1177/1558944716681974)
  • [L4] Treatment of a thumb UCL complete rupture (Grade III) using a custom-made hinged splint shows promise in the conservative management of compliant patients. [7] (10.1016/j.jht.2009.10.001)
  • [L3] Primary suture anchor repair without ligament reconstruction appears to be a safe and effective treatment option for patients' thumb UCL injuries, even in the chronic setting. [8] (10.1016/j.jhsg.2022.02.008)
  • [L5] No static ligament reconstruction restores the normal stability characteristics of the thumb UCL. [9] (10.1016/j.jhsa.2004.09.012)
  • [L4] This method allowed early postoperative rehabilitation and provided stability of the thumb MP joint and excellent clinical outcomes. [10] (10.1016/j.otsr.2019.01.008)
  • [L5] Sequential tearing of the thumb UCL leads to progressive instability of the MCP joint. [11] (10.1177/1558944719868518)
  • [L4] Return-to-play rates after surgical treatment of thumb UCL injuries are high, with reassuring return to preinjury level of play with few complications. [12] (10.1016/j.jhsg.2023.03.005)
  • [L4] Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft. [13] (10.1016/j.jhsa.2024.05.005)
  • [L3] Both repair methods are safe and effective for treating thumb ulnar collateral ligament injuries. [14] (10.1097/prs.0b013e3181882163)
  • [L5] [15] (10.1016/j.csm.2014.09.004)
  • [L5] In this model, thumb UCL repair with suture tape augmentation demonstrated greater maximum and clinical failure loads compared with nonaugmented repair at time 0, that is, without any biological healing. [16] (10.1016/j.jhsa.2018.02.002)
  • [L5] All UCL reconstructions failed by fracture: 8/11 at the proximal phalanx and 3/11 at the metacarpal. [17] (10.1016/j.jhsa.2026.04.009)
  • [L4] Ultrasonography (US) has evolved as a reliable adjunct to clinical examination in evaluation of the UCL of the thumb. [18] (10.1148/rg.264055117)
  • [L4] [19] (10.1016/j.jhsa.2024.12.003)
  • [L4] MRI evaluation reveals greater details enabling better understanding and management of ulnar collateral ligament injuries of the thumb MCP joint. [20] (10.1016/s0363-5023(09)60139-8)
  • [L4] Our 4-stage, treatment-oriented classification of thumb UCL injury is based on the degree of UCL displacement, with correlation with the likelihood of success with either immobilization or operative intervention. [21] (10.1016/j.jhsa.2014.08.033)
  • [L5] Complications are rare and most patients show preservation of motion, key pinch, and grip strength. [22] (10.1016/j.ocl.2014.11.007)
  • [L5] The functional results of operative treatment are excellent, resulting in a stable and painless thumb in the vast majority of cases. [23] (10.5435/00124635-199707000-00006)
  • [L4] This is the first clinical application of an accelerated rehabilitation protocol in athletes following thumb MCP UCL repair. [25] (10.1016/j.jht.2022.07.007)
  • [L4] The investigation demonstrates right–left differences and differences between clinical and fluoroscopic testing of which practitioners should be aware when making treatment decisions for UCL injury of the thumb MCP joint. [26] (10.1007/s11552-013-9500-2)
  • [L5] [27] (10.1177/17531934241311826)
  • [L4] Comparison with the uninjured contralateral thumb is unreliable in many individuals due to significant variation between right and left thumbs. [28] (10.1177/1753193408100957)
  • [L1] [29] (10.1177/17531934241274612)
  • [L4] There is a high rate of return to sport in the NFL following thumb UCL surgery. [31] (10.1177/1558944718760001)
  • [L4] When no fracture is present, a proper physical examination of an injured thumb is sufficient to determine the degree of instability of the ulnar collateral ligament, and a five-stage grading system is helpful in separating injuries into operative and non-operative groups. [32] (10.2106/00004623-198668090-00003)
  • [Paper] The use of suture anchor repair with suture tape augmentation for thumb UCL injuries is a treatment option that allows for early range of motion with satisfactory early outcomes that are comparable to intraosseous suture anchor repair. [33] (10.1055/s-0040-1710154)
  • [L5] Biomechanically, there are no treatments of repair or reconstruction using native tissues that provide equivalent strength to the preinjured ligament. [35] (10.5435/jaaos-d-22-00112)
  • [L4] [36] (10.1016/j.injury.2009.01.107)
  • [L5] Single- and double-bundle UCL reconstructions of the thumb MCP joint have comparable biomechanical properties in regard to joint congruity under valgus load. [37] (10.1177/1558944717744338)
  • [L5] The reconstruction tunnel positioning of triangular configuration with apex proximal stabilizes the thumb MCP joint while maintaining flexion/extension range of motion. [39] (10.1016/j.jhsa.2005.05.004)
  • [L5] Although both ST and SA constructs recapitulate native joint stiffness, repair with ST demonstrated the greatest biomechanical strength in stiffness and load-to-failure. [41] (10.1016/j.jhsa.2021.09.028)
  • [L5] Variations in thumb MCP joint rotation during stress testing may influence clinical interpretation, and standardization of testing with the thumb MCP joint in neutral rotation is recommended. [42] (10.1016/j.jhsa.2013.11.044)
  • [L5] In flat MCP joints, the RA is more dorsal and distal in the metacarpal head compared to round joints, resulting in a hinged flexion motion. [43] (10.1016/j.jhsa.2023.10.001)
  • [L4] Nonbiological ligament reconstruction of the thumb ulnar collateral ligament generates short-term outcomes comparable with those of BLR, potentially allowing for expedited recovery and rehabilitation. [44] (10.1016/j.jhsa.2024.01.008)
  • [L4] [45] (10.1016/j.jhsa.2011.06.004)
  • [L4] [46] (10.1054/jhsb.2002.0838)
  • [L5] In round joints, only the non-anatomic Glickel procedure restores normal ROM and stability, while in flat joints, the Glickel procedure and a modified Fairhurst configuration with origins dorsal in the metacarpal head restore ROM and stability. [50] (10.1177/17531934231164260)
  • [L5] The hook plate construct was biomechanically superior to the suture anchor construct for fixation of thumb metacarpophalangeal joint UCL fracture-avulsions with regard to load to failure. [51] (10.1016/j.jhsa.2015.11.016)
  • [L5] Thumb UCL repair with suture tape augmentation is able to restore varusevalgus kinematics after complete UCL tear without over-constraining the joint. [53] (10.1016/j.jhsa.2019.09.005)
  • [L4] Ultrasonography is not adequate for identifying dislocated ulnar collateral ligaments of the metacarpophalangeal joint of the thumb. [54] (10.1080/02844319950159307)
  • [L4] Collegiate football athletes treated for thumb UCL injuries with suture anchor repair had quick return to play, reliable return to the same level of activity, and excellent long-term clinical outcomes. [55] (10.1016/j.jhsa.2014.06.132)
  • [L5] This case highlights that clinical assessment of a thumb ulnar collateral ligament injury should be supplemented with radiographs, as underlying pathology, such as an enchondroma, may be a factor. [56] (10.1177/17531934251315313)
  • [L5] [57] (10.1016/j.jht.2021.04.016)

See Also

References

[1] Surgical Management of Thumb Ulnar Collateral Ligament Injuries: A Systematic Review and Meta-analysis of 614 Patients With a Minimum 1 Year Follow-up. JAAOS: Global Research and Reviews. 2025. DOI: 10.5435/jaaosglobal-d-25-00082

[2] Injury to the Ulnar Collateral Ligament of the Thumb. HAND. 2008. DOI: 10.1007/s11552-008-9145-8

[3] Patient-Reported Outcomes and Function After Surgical Repair of the Ulnar Collateral Ligament of the Thumb. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.05.003

[4] Performance and Return to Sport After Thumb Ulnar Collateral Ligament Repair in Major League Baseball Players. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967117747268

[5] Management of Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries. Journal of Bone and Joint Surgery. 2012. DOI: 10.2106/jbjs.k.01024

[6] Variation in the Rate of Surgery for Ulnar Collateral Ligament Injury of the Metacarpophalangeal Joint of the Thumb. HAND. 2016. DOI: 10.1177/1558944716681974

[7] Treatment of Grade III Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries with Early Controlled Motion Using a Hinged Splint. Journal of Hand Therapy. 2010. DOI: 10.1016/j.jht.2009.10.001

[8] A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.02.008

[9] Reconstruction of the ulnar collateral ligament of the thumb metacarpophalangeal joint: A cadaver study. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2004.09.012

[10] Mini hook plate fixation for thumb ulnar collateral ligament avulsion fracture: A technical report. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2019.01.008

[11] Biomechanical Analysis of Thumb Ulnar Collateral Ligament Tear Kinematics. HAND. 2019. DOI: 10.1177/1558944719868518

[12] Return to Play After Thumb Ulnar Collateral Ligament Injuries Managed Surgically in Athletes—A Systematic Review. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.03.005

[13] Patient-Reported and Clinical Outcomes After Tendon Autograft Reconstruction of the Thumb Ulnar Collateral Ligament. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.05.005

[14] Repair of Acute Ulnar Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint: A Retrospective Comparison of Pull-Out Sutures and Bone Anchor Techniques. Plastic and Reconstructive Surgery. 2008. DOI: 10.1097/prs.0b013e3181882163

[15] Thumb Ulnar Collateral and Radial Collateral Ligament Injuries. Clinics in Sports Medicine. 2015. DOI: 10.1016/j.csm.2014.09.004

[16] Suture Tape Augmentation of the Thumb Ulnar Collateral Ligament Repair: A Biomechanical Study. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.02.002

[17] Biomechanical Strength of Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Reconstruction With Button Autograft and Suture Suspension (BASS) Technique in a Cadaveric Osteolysis Model. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.04.009

[18] US Diagnosis of UCL Tears of the Thumb and Stener Lesions: Technique, Pattern-based Approach, and Differential Diagnosis. RadioGraphics. 2006. DOI: 10.1148/rg.264055117

[19] The Displaced Fleck Sign: Description of a Radiographic Finding Consistent with Grade III Thumb Ulnar Collateral Ligament Tears with Stener Lesions. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.12.003

[20] MRI Classification of Ulnar Collateral Ligament Injuries of the Thumb MCP Joint. The Journal of Hand Surgery. 2009. DOI: 10.1016/s0363-5023(09)60139-8

[21] Gamekeeper’s Thumb—A Treatment-Oriented Magnetic Resonance Imaging Classification. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.08.033

[22] Ulnar Collateral Ligament Injuries of the Thumb. Orthopedic Clinics of North America. 2015. DOI: 10.1016/j.ocl.2014.11.007

[23] Injuries to the Ulnar Collateral Ligament of the Thumb Metacarpophalangeal Joint. Journal of the American Academy of Orthopaedic Surgeons. 1997. DOI: 10.5435/00124635-199707000-00006

[25] Accelerated rehabilitation following thumb ulnar collateral ligament repair with suture tape augmentation: A case series of professional basketball players. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2022.07.007

[26] Fluoroscopy-Assisted Stress Testing of the Thumb Metacarpophalangeal Joint to Assess the Ulnar Collateral Ligament. HAND. 2013. DOI: 10.1007/s11552-013-9500-2

[27] Re. Dean B, Rodrigues J, Riley N, Rabey N, Donnison E, Challen K, Bradford S; BSSH BEST UCL Guideline Development Group. Guideline on managing thumb ulnar collateral ligament injuries: the British Society of Surgery for the Hand Evidence for Surgical Treatment (BEST) findings and recommendations. J Hand Surg Eur. 2024, 49: 1195–201. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241311826

[28] Clinical Testing of Ulnar Collateral Ligament Injuries of the Thumb. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408100957

[29] Guideline on managing thumb ulnar collateral ligament injuries: the British Society of Surgery for the Hand Evidence for Surgical Treatment (BEST) findings and recommendations. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241274612

[31] Performance and Return to Sport After Thumb Ulnar Collateral Ligament Surgery in National Football League Players. HAND. 2018. DOI: 10.1177/1558944718760001

[32] Rupture and displacement of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Preoperative diagnosis.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668090-00003

[33] Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Journal of Hand and Microsurgery. 2022. DOI: 10.1055/s-0040-1710154

[35] Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injuries: Management and Biomechanical Evaluation. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-00112

[36] Ulnar collateral ligament injuries of the thumb: 10 years of surgical experience. Injury. 2009. DOI: 10.1016/j.injury.2009.01.107

[37] Single-Bundle vs Double-Bundle (Anatomical) Reconstruction of the Thumb Ulnar Collateral Ligament: Biomechanical Study. HAND. 2017. DOI: 10.1177/1558944717744338

[39] Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries: A Biomechanical Simulation Study of Four Static Reconstructions. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2005.05.004

[41] Biomechanical Comparison of 3 Thumb Ulnar Collateral Ligament Repair Methods. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.09.028

[42] The Influence of Thumb Metacarpophalangeal Joint Rotation on the Evaluation of Ulnar Collateral Ligament Injuries: A Biomechanical Study in a Cadaver Model. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.11.044

[43] Thumb Metacarpophalangeal Joint Kinematics and Elongation of the Ulnar Collateral Ligament. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.10.001

[44] Biological Versus Nonbiological Reconstruction of the Ulnar Collateral Ligament of the Thumb Metacarpophalangeal Joint: A Retrospective Study. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.01.008

[45] Chronic Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Insufficiency. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.06.004

[46] Treatment of “Gamekeeper's Thumb” by Reconstruction of the Ulnar Collateral Ligament. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2002.0838

[50] Thumb metacarpophalangeal joint morphology and reconstruction of the ruptured ulnar collateral ligament. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231164260

[51] Hook Plate Versus Suture Anchor Fixation for Thumb Ulnar Collateral Ligament Fracture-Avulsions: A Cadaver Study. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.11.016

[53] Kinematics of Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.09.005

[54] ULTRASONOGRAPHY MAY BE MISLEADING IN THE DIAGNOSIS OF RUPTURED AND DISLOCATED ULNAR COLLATERAL LIGAMENTS OF THE THUMB. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. 1995. DOI: 10.1080/02844319950159307

[55] Return to Football and Long-Term Clinical Outcomes After Thumb Ulnar Collateral Ligament Suture Anchor Repair in Collegiate Athletes. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.132

[56] Clinical thumb ulnar collateral ligament injury owing to a pathological fracture through an enchondroma of the proximal phalanx. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251315313

[57] Can we do it faster? accelerated rehabilitation following thumb ulnar collateral ligament repair with suture tape augmentation. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2021.04.016

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