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Thumb UCL Repair

48 citationsUpdated Aug 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Untreated ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal joint can lead to long-term pain and functional limitations [1]. Conservative management fails in 75% of cases with complete rupture of the ulnar collateral ligament of the thumb [2]. Treatment of a thumb UCL complete rupture (Grade III) using a custom-made hinged splint shows promise in the conservative management of compliant patients [10]. The rate of surgery for acute thumb MP UCL injury varies based on patient characteristics and the individual treating surgeon [5].

Patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline [4]. 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 [6]. Both pull-out sutures and bone anchor techniques are safe and effective for treating thumb ulnar collateral ligament injuries [15]. 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 [29]. Mini hook plate fixation could be an alternative treatment technique for thumb UCL avulsion fractures [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 [7]. 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 [9].

Anatomy & Pathophysiology

Ligamentous Stability and Reconstruction

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 [8]. Furthermore, no treatments of repair or reconstruction using native tissues provide equivalent strength to the preinjured ligament biomechanically [31].

Reconstruction Techniques: * Single- and double-bundle reconstructions: These have comparable biomechanical properties regarding joint congruity under valgus load [27]. * Tunnel configuration: A triangular configuration reconstruction tunnel with apex proximal stabilizes the thumb MCP joint while maintaining flexion/extension range of motion [28]. * Repair constructs: Repair with ST constructs demonstrated the greatest biomechanical strength in stiffness and load-to-failure, while both ST and SA constructs recapitulate native joint stiffness [35]. * Chronic injury options: The surgical technique using extensor pollicis brevis for chronic UCL injury provides good MCP joint strength and stability with few postoperative complications [39]. Implant-free anatomical reconstruction of chronic UCL injuries achieved stable intra-osseous fixation and restored grip, pinch strength, and range of motion [40].

Osseous Morphology and Surgical Outcomes

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 [36]. In flat MCP joints, the radial attachment of the UCL is more dorsal and distal in the metacarpal head compared to round joints, resulting in a hinged flexion motion [37].

Reconstruction Efficacy by Joint Morphology: * Round joints: Only the non-anatomic Glickel procedure restores normal ROM and stability [43]. * Flat joints: The Glickel procedure and a modified Fairhurst configuration with origins dorsal in the metacarpal head restore ROM and stability [43].

Mini hook plate fixation is an alternative treatment technique for thumb UCL avulsion fractures [3]. Operative treatment for thumb UCL injuries results in a stable and painless thumb in the vast majority of cases [22]. Most patients with thumb UCL injuries show preservation of motion, key pinch, and grip strength [21].

Clinical Assessment and Rehabilitation

Comparison with the uninjured contralateral thumb is unreliable for clinical testing of UCL injuries due to significant variation between right and left thumbs [26]. An accelerated rehabilitation protocol has been clinically applied in athletes following thumb MCP UCL repair [24].

Biomechanical Bracing and Prevention

A radial-based thumb MCP-stabilizing orthosis effectively reduces the degree of abduction at the thumb MCP joint up to at least 100 N [34]. Restraint of extreme movements is necessary to prevent skier's thumb, potentially achieved by a properly designed ski-glove that prevents extreme thumb movements and incorporates a mechanism for ski-pole ejection [41].

Classification

Three-Tier System: Grade I injuries involve minor tearing without instability [18]. Grade II injuries consist of a partial ligament tear with increased joint laxity but a definitive end point on clinical testing [18]. Grade III injuries represent a complete ligament tear with gross instability on examination [18] [18].

Treatment Correlation: Grade I and II injuries are generally treated nonoperatively with immobilization [18]. Grade III injuries require surgical repair or reconstruction depending on the chronicity of the injury [18].

Alternative Grading Models: A five-stage grading system helps separate thumb UCL injuries into operative and non-operative groups when no fracture is present [38]. A 4-stage, treatment-oriented classification is based on the degree of UCL displacement and correlates with the likelihood of success with either immobilization or operative intervention [13].

Imaging Modalities: Ultrasonography (US) is a reliable adjunct to clinical examination for the evaluation of thumb UCL injuries [12]. Ultrasound can visualize torn and proximal Stener lesions, including thickened adductor aponeurosis [42]. Ultrasound can also identify adductor aponeurosis injury with an intact ulnar collateral ligament [42]. MRI evaluation reveals greater details enabling better understanding and management of thumb UCL injuries [19]. In MRI scans, 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 [42]. A UCL rupture without displacement depicts a discontinuous distal end of the UCL with intermediate signal intensity remaining in the normal position [42]. A displaced UCL appears retracted or folded onto itself proximally [42].

Radiographic Signs: The displaced fleck sign is a radiographic finding consistent with Grade III thumb UCL tears with Stener lesions [18]. This sign represents a small avulsion fracture of the UCL insertion from the proximal phalanx base that has displaced proximally and ulnarly [18].

Clinical Presentation

Evaluation of thumb ulnar collateral ligament (UCL) injuries integrates clinical examination with advanced imaging to guide management. Ultrasonography (US) serves as a reliable adjunct to physical examination [12], while Magnetic Resonance Imaging (MRI) provides detailed anatomical visualization that enhances understanding and management of UCL injuries at the metacarpophalangeal (MCP) joint [19]. Radiographic assessment identifies the displaced fleck sign, a finding consistent with Grade III tears and Stener lesions [18].

Clinical stability is assessed via stress testing, though practitioners must account for inherent asymmetries. Fluoroscopy-assisted stress testing reveals right–left differences and discrepancies between clinical and fluoroscopic findings, which influence treatment decisions [25]. However, comparison with the uninjured contralateral thumb is unreliable in many individuals due to significant inter-hand variation [26].

Injury severity is categorized by a 4-stage, treatment-oriented classification based on the degree of UCL displacement, which correlates with the likelihood of success for immobilization versus operative intervention [13]. Patients with approximately 30° or less of angulation with radial deviation stress at the thumb MCP and no palpable displaced ligament are unlikely to have a Stener lesion [33]. While some hand surgeons advocate for surgical treatment of any complete UCL rupture, the accepted primary indication remains the presence of a Stener lesion [33].

Operative outcomes are generally favorable. Thumb UCL reconstruction with a tendon autograft improves patient-reported outcomes, including pain and function [14]. Thumb UCL repair with suture tape augmentation demonstrates greater maximum and clinical failure loads compared with nonaugmented repair at time 0, prior to biological healing [16]. Complications are rare, and most patients preserve motion, key pinch, and grip strength [21]. Functional results of operative treatment are excellent, resulting in a stable and painless thumb in the vast majority of cases [22].

Investigations

Plain radiography: 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 [49].

Stress testing: Fluoroscopy-assisted stress testing demonstrates right–left differences and differences between clinical and fluoroscopic testing, which practitioners should be aware of when making treatment decisions for UCL injury of the thumb MCP joint [25].

Ultrasonography: Ultrasonography is not adequate for identifying dislocated ulnar collateral ligaments of the metacarpophalangeal joint of the thumb [47].

Treatment

Non-Operative

The provided evidence does not support specific non-operative management protocols for thumb UCL injuries; therefore, this section is omitted.

Operative

Indications: 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 [51].

Surgical Approach / Technique: For chronic injuries, a simple and effective surgical technique involves reconstruction of the UCL at the thumb MCP joint using the adjacent adductor pollicis tendon under a wide-awake approach, which allows for intraoperative tension confirmation [50]. Regarding tunnel positioning for reconstruction, a triangular configuration with the apex proximal stabilizes the thumb MCP joint while maintaining flexion/extension range of motion [28]. Single- and double-bundle UCL reconstructions of the thumb MCP joint have comparable biomechanical properties in regard to joint congruity under valgus load [27].

Implant Selection: In a cadaveric osteolysis model, all UCL reconstructions failed by fracture, with 8/11 failures occurring at the proximal phalanx and 3/11 at the metacarpal [17]. For fixation of thumb metacarpophalangeal joint UCL fracture-avulsions, the hook plate construct was biomechanically superior to the suture anchor construct with regard to load to failure [45]. Thumb UCL repair with suture tape augmentation is able to restore varus-valgus kinematics after complete UCL tear without over-constraining the joint [46]. 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 [23].

Pain Management: The provided evidence does not specify analgesia regimens for thumb UCL procedures; therefore, this section is omitted.

Adjuncts: The provided evidence does not specify adjunctive measures such as tourniquet use or tranexamic acid for thumb UCL procedures; therefore, this section is omitted.

Setting of Care: The provided evidence does not specify outpatient versus inpatient setting requirements for thumb UCL procedures; therefore, this section is omitted.

Revision: The provided evidence does not cover revision principles for thumb UCL procedures; therefore, this section is omitted.

Other Considerations: Advances in surgical technology allow for accelerated rehabilitation following thumb UCL repair with suture tape augmentation, enabling individuals to successfully return to unrestricted work, activity, and sports by 5-6 weeks post-surgery [52].

Recovery

Rehabilitation protocol: In cases involving retracted ulnar collateral ligament (UCL) remnants, condylar shaving provides a shorter course for the tissue, facilitating primary repair in the chronic setting and in difficult acute repairs [30].

Key Evidence

  • [L5] Untreated ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal joint can lead to long-term pain and functional limitations. [1] (10.2106/jbjs.k.01024)
  • [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)
  • [L4] It could be an alternative treatment technique for thumb UCL avulsion fractures. [3] (10.1016/j.otsr.2019.01.008)
  • [L2] Patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline. [4] (10.1016/j.jhsa.2023.05.003)
  • [L3] The rate of surgery for acute thumb MP UCL injury varies based on patient characteristics and the individual treating surgeon. [5] (10.1177/1558944716681974)
  • [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. [6] (10.1016/j.jhsg.2022.02.008)
  • [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. [7] (10.1016/j.jhsg.2023.03.005)
  • [L5] No static ligament reconstruction restores the normal stability characteristics of the thumb UCL. [8] (10.1016/j.jhsa.2004.09.012)
  • [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. [9] (10.1177/2325967117747268)
  • [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. [10] (10.1016/j.jht.2009.10.001)
  • [L5] Sequential tearing of the thumb UCL leads to progressive instability of the MCP joint. [11] (10.1177/1558944719868518)
  • [L4] Ultrasonography (US) has evolved as a reliable adjunct to clinical examination in evaluation of the UCL of the thumb. [12] (10.1148/rg.264055117)
  • [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. [13] (10.1016/j.jhsa.2014.08.033)
  • [L4] Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft. [14] (10.1016/j.jhsa.2024.05.005)
  • [L3] Both repair methods are safe and effective for treating thumb ulnar collateral ligament injuries. [15] (10.1097/prs.0b013e3181882163)
  • [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] [18] (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. [19] (10.1016/s0363-5023(09)60139-8)
  • [L5] Complications are rare and most patients show preservation of motion, key pinch, and grip strength. [21] (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. [22] (10.5435/00124635-199707000-00006)
  • [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. [23] (10.1016/j.jhsa.2024.01.008)
  • [L4] This is the first clinical application of an accelerated rehabilitation protocol in athletes following thumb MCP UCL repair. [24] (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. [25] (10.1007/s11552-013-9500-2)
  • [L4] Comparison with the uninjured contralateral thumb is unreliable in many individuals due to significant variation between right and left thumbs. [26] (10.1177/1753193408100957)
  • [L5] Single- and double-bundle UCL reconstructions of the thumb MCP joint have comparable biomechanical properties in regard to joint congruity under valgus load. [27] (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. [28] (10.1016/j.jhsa.2005.05.004)
  • [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. [29] (10.1055/s-0040-1710154)
  • [L5] This approach provides a shorter course for the retracted UCL remnants allowing primary repair in the chronic setting and in the difficult acute repair. [30] (10.1097/bth.0b013e3181c3f14e)
  • [L5] Biomechanically, there are no treatments of repair or reconstruction using native tissues that provide equivalent strength to the preinjured ligament. [31] (10.5435/jaaos-d-22-00112)
  • [L5] [33] (10.1016/j.jhsa.2008.09.025)
  • [Paper] This investigation provides objective evidence that our radial-based thumb MCP-stabilizing orthosis effectively reduces the degree of abduction that occurs at the thumb MCP joint up to at least 100 N. [34] (10.1016/j.jht.2017.06.002)
  • [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. [35] (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. [36] (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. [37] (10.1016/j.jhsa.2023.10.001)
  • [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. [38] (10.2106/00004623-198668090-00003)
  • [L4] The surgical technique provides good MCP joint strength and stability and allows a good functional recovery with few postoperative complications. [39] (10.1016/j.jhsg.2020.10.002)
  • [L4] The surgical procedure achieved stable intra-osseous fixation and restored grip, pinch strength, and range of motion while avoiding drawbacks associated with implants. [40] (10.1177/17531934231182895)
  • [L4] Restraint of these two extremes of movement is necessary to prevent this type of injury, and it is hoped that the required restraint may be achieved by the wearing of a properly designed ski-glove which not only prevents extreme movements of the thumb but also incorporates a mechanism for the ejection of the ski-pole. [41] (10.1016/0020-1383(86)90337-2)
  • [L5] [42] (10.1177/1558944716661999)
  • [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. [43] (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. [45] (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. [46] (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. [47] (10.1080/02844319950159307)
  • [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. [49] (10.1177/17531934251315313)
  • [L4] The study demonstrates a simple and effective surgical technique for reconstruction of the UCL at the thumb MCP joint for chronic injury using the adjacent adductor pollicis tendon under a wide-awake approach, allowing for intraoperative tension confirmation. [50] (10.1016/j.jhsa.2018.11.012)
  • [L4] [51] (10.1016/j.injury.2009.01.107)
  • [L5] [52] (10.1016/j.jht.2021.04.016)

References

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

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

[3] 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

[4] 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

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

[6] 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

[7] 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

[8] 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

[9] 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

[10] 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

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

[12] 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

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

[14] 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

[15] 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

[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] 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

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

[22] 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

[23] 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

[24] 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

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

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

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

[28] 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

[29] 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

[30] Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Repair With Condylar Shaving. Techniques in Hand & Upper Extremity Surgery. 2009. DOI: 10.1097/bth.0b013e3181c3f14e

[31] 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

[33] Injury at the Thumb UCL: Is There a Stener Lesion?. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.09.025

[34] Efficacy of a radial-based thumb metacarpophalangeal-stabilizing orthosis for protecting the thumb metacarpophalangeal joint ulnar collateral ligament. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2017.06.002

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

[36] 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

[37] 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

[38] 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

[39] The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury Using Extensor Pollicis Brevis: Surgical Technique. Journal of Hand Surgery Global Online. 2021. DOI: 10.1016/j.jhsg.2020.10.002

[40] Implant-free anatomical reconstruction of thumb metacarpophalangeal joint chronic ulnar collateral ligament injuries. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231182895

[41] Skier's thumb—a method of prevention. Injury. 1986. DOI: 10.1016/0020-1383(86)90337-2

[42] The Stener Lesion: Historical Perspective and Evolution of Diagnostic Criteria. HAND. 2016. DOI: 10.1177/1558944716661999

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

[45] 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

[46] 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

[47] 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

[49] 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

[50] Ulnar Collateral Ligament Reconstruction of Thumb Metacarpophalangeal Joint With Adductor Pollicis Tendon Using the Wide-Awake Approach. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.11.012

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

[52] 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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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.