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Thumb UCL Repair

87 citationsUpdated Oct 2026
Illustration: Thumb UCL Repair

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

Overview

Surgical management of thumb ulnar collateral ligament (UCL) injuries yields overall favorable results [3], with patient-reported outcomes improving significantly at three and 12 months post-operatively compared to baseline [4]. Untreated injury to the thumb metacarpophalangeal joint can result in long-term pain and functional limitations [6]. Consequently, 75% of cases involving complete rupture fail to heal with conservative treatment [8]. While the rate of surgery for acute injury varies based on patient characteristics and the treating surgeon [13], primary suture anchor repair without ligament reconstruction is a safe and effective option, even in the chronic setting [11]. Intraosseous suture anchor repair is similarly safe and effective for complete tears [17], and both pull-out sutures and bone anchor techniques are validated treatments [27].

Suture tape augmentation offers short-term outcomes comparable to other repair methods [12] and permits early range of motion with satisfactory early results [60]. Biomechanical studies demonstrate that suture tape augmentation greatly increases load to failure [2] and provides greater maximum and clinical failure loads compared with nonaugmented repair at time zero, even without biological healing [21]. A controlled active motion therapy protocol following suture anchor repair is biomechanically safe [9]. Alternative techniques include the Fiji Anchor, which leads to excellent clinical outcomes with a minor complication rate, though long-term dangers and cost-effectiveness remain unknown [63]. Mini hook plate fixation serves as an alternative for avulsion fractures [1], and the dorsal approach is used safely for repair and reconstruction of both ulnar and radial collateral ligaments [15].

Return-to-play rates after surgical treatment are high, with reassuring return to preinjury level of play and few complications [18]. In Major League Baseball, players who underwent thumb UCL repair played a similar number of games per season and had similar career lengths as controls [5]. Conservative management using a custom-made hinged splint shows promise for compliant patients with Grade III ruptures [10]. Notably, transection of the UCL complex did not significantly alter the position of the proximal phalanx relative to the metacarpal during simulated tip pinch [7].

Anatomy & Pathophysiology

Osseous & Kinematic Framework

The thumb ray is the shortest and most divergent of the longitudinal arches, consisting of a metacarpal and two phalanges [49, 73]. It is more mobile and proximal than the other rays, with the thumb metacarpal making an angle of about 45 degrees with the second metacarpal in the sagittal plane [49]. The transverse axis of the palm, corresponding to the metacarpophalangeal articulations, forms an acute angle of approximately 75 degrees with the longitudinal axis [49]. The first ray continues the external column of the carpus formed by the scaphoid and trapezium, with the trapezium clearly angled out in front of the carpal plane [49]. The thumb metacarpal is independent and articulates with the trapezium, granting the thumb ray considerable mobility and independence [73]. As the keystone of the longitudinal arch, the thumb MCP joint is essential to the support of both the longitudinal arch and the transverse metacarpal arch [73]. The thumb represents the dominant element of the hand, giving value to all other digits [73]. The thumb MCP joint is a functional group arranged in kinetic chains with interdependence between articulations; the position of the metacarpophalangeal joint affects the position of the proximal interphalangeal joint [78]. Single articular movements around a fixed perpendicular axis do not exist in the hand; almost all movements are around oblique and variable axes, resulting in combined movements [78]. The equilibrium between elements in the same osteoarticular chain results from active dynamic balance between antagonist muscles and passive restraining action of ligaments [78]. The thumb MCP joint is susceptible to deformation due to the polyarticulated chain structure of the hand skeleton [49]. Epiphyseal plates are located at the proximal ends of the phalanges and the first metacarpal [49].

Ligamentous Stabilizers

The thumb MCP joint is stabilized by collateral ligaments and a thick volar articular capsule known as the volar plate [73]. The ulnar collateral ligament (UCL) and radial collateral ligament (RCL) are essential lateral stabilizers of the thumb MCP joint [46]. The lateral accessory ligaments, sagittal bands of the extensor apparatus, and the first annular segment of the flexor tendon pulley insert onto the volar plate [73]. The volar plates are interconnected by the transverse interglenoid ligament and prevent hyperextension of the MCP joint [73]. The dorsal fibrocartilage acts as a secondary stabilizer of the thumb MCP joint, working in tandem with the radial collateral ligament [121]. The thumb collateral ligaments at the metacarpophalangeal joint are important for precision grip and pinch [45].

Vascular & Soft Tissue Anatomy

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 [74]. It emerges onto the subcutaneous palmar tissue at the level of the cutaneous flexion crease of the metacarpophalangeal joint, where it divides into two terminal rami, the collateral palmar arteries of the thumb [74]. The dorsal arteries of the thumb vascularize the posterior area and originate from palmar arteries at the level of the first metacarpal, running laterally along the MCP joint and continuing obliquely from volar to dorsal [74]. The superficial palmar fascia covers a triangular area of the central palm, with no central band for the thumb [80]. A subdermal fascial layer borders the periphery of the web spaces from roughly the radial thumb sesamoid to the ulnar side of the small finger’s proximal flexion crease [80]. The distal first web space ligament between the thumb and index is in continuity with the natatory ligament that spans the remaining web spaces [80]. The web space of the thumb is the largest and deepest of the hand [68].

Cutaneous Considerations

The dorsal skin of the hand is thin, possesses a normal pilosebaceous system, and has loose connections with deeper planes allowing free gliding [79]. Flexion at the metacarpophalangeal joint alone requires an average skin lengthening of 1.25 cm (range 1–2 cm) [79]. The dorsal and palmar areas of skin are independent due to a system of adhesions that anchors their common boundary to the underlying plane [79]. In the proximal part of the first phalanx, skin fixation occurs in a straight line in the plane of the commissural crest, taking the form of small fibrils arranged in a fan shape [79]. The necessary skin to cover the thumb distal to the metacarpophalangeal joint is about 9 cm wide and 8 cm long [72]. Skin loss of the thumb and first metacarpal is 13 cm wide and 12 cm long [72]. The thumb has a more proximal and lateral position, allowing movement inward and outward from the palm [68].

Pathophysiology & Injury Mechanisms

Collateral ligament injuries of the thumb MCP joint comprise up to 86% of all injuries to the thumb [46]. The UCL is five times more common than RCL injury in the context of thumb collateral ligament trauma [137]. RCL injuries account for 10% to 42% of collateral ligament injuries and are less common than UCL injuries [46]. RCL injuries are more likely to require surgical intervention than UCL injuries [46]. Injuries to thumb collateral ligaments can result in pain, instability, and diminished pinch and grip strength [45, 46].

UCL Injury: UCL injuries typically result from sudden thumb MCP joint abduction and/or extension (radially deviated force) [46]. Injury to the UCL is often the result of rapid abduction of the thumb, or from force applied directly to the thumb or a fall on an outstretched hand with an abducted thumb [137]. The mechanism of UCL injury may be associated with damage to the dorsal capsule and the ulnar aspect of the volar plate [137]. The UCL is prone to Stener’s lesions or interposition of the adductor aponeurosis [30].

RCL Injury: RCL injuries usually result from sudden thumb MCP joint adduction (ulnarly deviated force) or axial loading [46]. Disruption of the RCL leads to unopposed dynamic force of the adductor pollicis and flexor pollicis longus tendons [46]. In the setting of RCL disruption, the MCP joint is prone to a sequence of ligamentous laxity, joint instability, volar and ulnar subluxation, and degenerative joint disease [46]. The UCL and RCL injuries of the thumb occur through different mechanisms [45].

Surface Landmarks

The thumb MCP joint is not palpable in the palm, but its position can be derived from the flexion creases [81]. The MP joints lie approximately on a transverse line that begins in the distal palmar crease on the ulnar side and runs into the proximal crease on the radial border [81].

Classification

Grade I–III Classification: Thumb ulnar collateral ligament (UCL) tears are stratified into three grades based on ligament integrity and joint stability. Grade I involves minor tearing without instability, while Grade II presents as a partial ligament tear with increased joint laxity but a definitive end point [31]. Grade III is defined by a complete ligament tear and gross instability [31]. Treatment follows this stratification: Grade I and II injuries are generally managed nonoperatively with immobilization, whereas Grade III injuries, particularly those with a Stener lesion, require surgical repair or reconstruction depending on injury chronicity [31].

Five-Stage Grading System: A five-stage grading system is helpful in separating thumb UCL injuries into operative and non-operative groups when no fracture is present [59].

Four-Stage Treatment-Oriented Classification: A 4-stage, treatment-oriented classification of thumb UCL injury is based on the degree of UCL displacement and correlates with the likelihood of success with either immobilization or operative intervention [33].

Other Considerations: Imaging modalities provide critical adjuncts to clinical examination in the evaluation of the thumb UCL. Ultrasonography has evolved as a reliable adjunct to clinical examination [23]. MRI evaluation reveals greater details enabling better understanding and management of ulnar collateral ligament injuries of the thumb MCP joint [25]. In MRI scans, a normal UCL appears as a low-signal-intensity band medial to the MCP joint, with the distal attachment displaying over the base of the proximal phalanx [135]. In cases of UCL rupture without ligament displacement, MRI images depict a discontinuous distal end of the UCL with intermediate signal intensity remaining in the normal UCL position [135]. A displaced UCL on MRI appears retracted or folded onto itself proximally, often with the proximal end interposed by the adductor aponeurosis [135]. The "displaced fleck sign" is a radiographic finding consistent with Grade III thumb UCL tears with Stener lesions, characterized by a small avulsion fracture of the UCL insertion from the proximal phalanx base that has displaced proximally and ulnarly [31]. Fluoroscopy-assisted stress testing of the thumb MCP joint demonstrates right–left differences and differences between clinical and fluoroscopic testing [32].

Clinical Presentation

Injury Mechanism and Classification

Acute thumb ulnar collateral ligament (UCL) injuries most commonly occur during sports involving a radially-directed force at the metacarpophalangeal (MCP) joint [31]. These injuries are stratified into three grades: Grade I involves minor tearing without instability; Grade II presents as a partial tear with increased joint laxity but a definitive end point; and Grade III is a complete tear with gross instability [31]. Sequential tearing of the thumb UCL leads to progressive instability of the MCP joint [19].

Clinical Examination

Diagnosis of UCL incompetence remains a clinical rather than a radiographic diagnosis [53]. Examination involves abducting the thumb at the MP joint to assess the degree of instability [85]. Two main clinical criteria for UCL rupture are an excess of abduction over a specific cut-off value and excess laxity compared to the contralateral uninjured thumb [85]. The BSSH BEST guideline defines significant UCL laxity as no firm endpoint, or >20 degrees laxity versus the other side, or >30 degrees laxity [50]. Valgus instability of more than 30 degrees, or more than 10 degrees compared with the contralateral thumb in both flexion and extension, indicates complete rupture of the proper and accessory UCL [88]. Conversely, instability of the MCP joint in flexion indicates rupture of the proper UCL only [88]. Fluoroscopy-assisted stress testing demonstrates right–left differences and differences between clinical and fluoroscopic testing [32].

Stener Lesion Assessment

A palpable thickening on the ulnar aspect of the thumb metacarpal neck is strongly suggestive of a Stener lesion [86]. In this condition, the proximal stump of the ruptured UCL retracts proximal and superficial to the adductor aponeurosis [86]. Patients with approximately 30 degrees or less of angulation with radial deviation stress at the thumb MCP and no palpable displaced ligament are unlikely to have a Stener lesion [90].

Imaging

Plain radiographs are used to diagnose avulsion fractures, which are mostly located on the ulnar side of the proximal phalanx [91]. An avulsion fragment is considered dislocated if it is displaced more than 1 mm or if it is malrotated [91]. Stress radiographs have false-negative results of up to 25% of all patients [91]. MRI can be seen as a gold standard with a sensitivity of 96%-100% and specificity of 95-100% for UCL injury [91]. A 4-stage, treatment-oriented MRI classification of thumb UCL injury is based on the degree of UCL displacement and correlates with the likelihood of success with immobilization or operative intervention [33]. Ultrasonography has evolved as a reliable adjunct to clinical examination in evaluation of the UCL of the thumb [23]. In one study, ultrasound had a sensitivity of 65% and specificity of 61% for diagnosing displaced UCL ruptures [24]. In one study, ultrasound identified Stener lesions with a sensitivity of 36% [24]. A review found that three level 1 studies showed an overall sensitivity of 76% and a specificity of 81% for ultrasound in UCL injury diagnosis [24].

Investigations

Plain radiography: Radiographs are indicated to identify associated fractures and underlying pathology, such as an enchondroma, which may influence management [152]. The displaced fleck sign is a specific radiographic finding consistent with Grade III thumb ulnar collateral ligament tears with Stener lesions [31]. This sign consists of a small avulsion fracture of the ulnar collateral ligament insertion from the proximal phalanx base that has displaced proximally and ulnarly [31]. A flat thumb metacarpal head is not associated with a traumatic thumb ulnar collateral ligament tear [54].

MRI: Magnetic resonance imaging reveals greater details enabling better understanding and management of ulnar collateral ligament injuries of the thumb metacarpophalangeal joint [25]. MRI directly depicts ligament integrity [62]. In one study, magnetic resonance imaging was helpful in diagnosing a displaced ulnar collateral ligament in two cases and an intraligamentous injury in the other [140]. A corresponding T2 sequence coronal MRI can confirm the displacement of the torn ulnar collateral ligament with interposition of the adductor aponeurosis consistent with a Stener lesion [31].

Ultrasonography: Ultrasonography has evolved as a reliable adjunct to clinical examination in the evaluation of the thumb ulnar collateral ligament [23]. High-resolution ultrasound is increasingly used due to its accuracy, availability, and ability to evaluate and compare to the contralateral side [62]. Ultrasound directly depicts ligament integrity [62]. However, ultrasonography is not adequate for identifying dislocated ulnar collateral ligaments of the metacarpophalangeal joint of the thumb [148].

Other Considerations: Diagnosis of incompetence of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb remains a clinical rather than a radiographic diagnosis [53]. Clinical assessment should be supplemented with radiographs [152]. Fluoroscopy-assisted stress testing of the thumb metacarpophalangeal joint demonstrates right–left differences and differences between clinical and fluoroscopic testing [32]. Biomechanical studies indicate that transection of the ulnar collateral ligament complex did not significantly alter the position of the proximal phalanx relative to the metacarpal of the thumb during simulated tip pinch [7]. Sequential tearing of the thumb ulnar collateral ligament leads to progressive instability of the metacarpophalangeal joint [19]. In a cadaveric osteolysis model, all ulnar collateral ligament reconstructions failed by fracture, with 8/11 failures at the proximal phalanx and 3/11 at the metacarpal [22]. Arthroscopic repair of thumb metacarpophalangeal injuries enables a precise ligamentous diagnosis [149].

Treatment

Non-Operative

Untreated ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal joint can lead to long-term pain and functional limitations [6]. However, nonoperative treatment of partial ligament injuries with cast or splint immobilization will result in a stable and painless thumb [133].

Operative

Indications: Surgical management of thumb UCL injuries produces overall favorable results [3]. The rate of surgery for acute thumb MP UCL injury varies based on patient characteristics and the individual treating surgeon [13]. For patients with thumb UCL avulsion fracture injuries, MCP joint instability is a suitable indicator for surgical treatment [42].

Surgical Approach / Technique: The functional results of operative treatment are excellent, resulting in a stable and painless thumb in the vast majority of cases [55]. Methods adopted in the treatment of fresh ruptures of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb have been good [39]. 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 [17]. Both pull-out suture and bone anchor repair methods are safe and effective for treating thumb ulnar collateral ligament injuries [27]. The authors have used a described dorsal approach with safety and convenience over a several year period for repair and reconstruction of both the ulnar and radial collateral ligaments at the thumb metacarpophalangeal joint [15]. For chronic injuries, a method of reconstruction of the long standing rupture of ulnar collateral ligament of the thumb is described [40]. A simple and effective surgical technique for reconstruction of the UCL at the thumb MCP joint for chronic injury uses the adjacent adductor pollicis tendon under a wide-awake approach, allowing for intraoperative tension confirmation [153].

Implant Selection: 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 [21]. Thumb UCL repair with suture tape augmentation is able to restore varusevalgus kinematics after complete UCL tear without over-constraining the joint [146]. Augmenting the repair with anchored suture may prevent prolonged immobilization, expedite thumb motion, and improve postoperative recovery [154]. For avulsion fractures, 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 [142].

Alignment / Balancing Strategy: No static ligament reconstruction restores the normal stability characteristics of the thumb UCL [14]. Single- and double-bundle UCL reconstructions of the thumb MCP joint have comparable biomechanical properties in regard to joint congruity under valgus load [36]. Nonanatomic repairs of collateral ligament alter normal metacarpophalangeal joint range of motion [45]. This study demonstrates that nonanatomic reconstruction of the UCL alters normal MCP joint range of motion [131].

Other Considerations: Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft [26]. Nonbiological ligament reconstruction of the thumb ulnar collateral ligament generates short-term outcomes comparable with those of biological ligament reconstruction, potentially allowing for expedited recovery and rehabilitation [126]. Chronic collateral ligament reconstructions with tendon graft, although less successful than acute repair, can restore stability of the thumb MCP joint [45]. All UCL reconstructions failed by fracture: 8/11 at the proximal phalanx and 3/11 at the metacarpal [22]. Transection of the UCL complex did not significantly alter the position of the proximal phalanx relative to the metacarpal of the thumb [7].

Postoperative Rehabilitation and Outcomes: Supplemental thumb MP pin fixation more effectively protects the UCL from valgus strain compared to splinting alone [66]. 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 [5].

Complications

General Outcomes: Complications following thumb UCL repair are rare, with most patients demonstrating preservation of motion, key pinch, and grip strength [35]. Various surgical methods yield excellent outcomes with a low incidence of complications [143]. In a cohort of 49 patients, no complications requiring treatment were identified [24]. The extensor pollicis brevis tendon technique for chronic injuries provides good MCP joint strength and stability, allowing good functional recovery with few postoperative complications [144]. In a series of 8 patients treated with implant-free anatomical reconstruction using a palmaris longus tendon graft, good results were obtained [147].

Infection: In a study of 18 metacarpophalangeal joints treated with bone suture anchors, one surgical wound infection occurred [145]. In a study of arthroscopic treatment for acute complete thumb UCL tears, the only complication was a pin track infection [105]. This pin track infection resolved after wire removal and treatment with oral antibiotics [105]. The surgical wound infection in the bone suture anchor cohort fully resolved during the follow-up period [145].

Nerve Injury: In the bone suture anchor cohort, one transient neuropraxia over the radial collateral ligament occurred and fully resolved during follow-up [145]. In one patient, damage to a branch of the superficial radial nerve resulted in a painful neuroma on the dorso-ulna aspect of the thumb [134]. This painful neuroma was buried within the first dorsal interosseous muscle [134].

Instability and Graft Failure: One simple ligament plication performed more than 8 weeks post-injury suffered a further injury 2 months after surgery and ruptured [134]. In a cadaveric osteolysis model of UCL reconstruction with the BASS technique, all reconstructions failed by fracture [22]. Of the 11 UCL reconstructions in this model, 8 failed at the proximal phalanx and 3 failed at the metacarpal [22]. In a reconstruction series, five reconstructions were slightly lax at final follow-up [134].

Stiffness and Functional Deficits: Fourteen thumbs in the reconstruction series had slightly reduced flexion at both the metacarpophalangeal and interphalangeal joints [134]. Patients with this reduced flexion could only oppose the thumb tip to the base of the little finger and not to the distal palmar crease [134]. Five patients in the reconstruction series had reduced power grip [134]. Five patients experienced persistent aching of the metacarpophalangeal joint when pinching, which was mild and not disabling [134]. In a study of 18 metacarpophalangeal joints treated with bone suture anchors, one patient had a pulpto-palm distance of approximately 10 mm [145]. In a study of chronic UCL reconstructions, there was no significant change in pinch strength [28].

Pain: Four patients in the avulsion fracture group had mild intermittent pain caused by light activity [51]. Four patients in the rupture group had mild intermittent pain caused by light activity [51]. One patient who underwent simple ligament repair more than 8 weeks after surgery still experienced pain 8 months post-surgery but declined further surgery [134].

Other Considerations: 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 [51]. Thumb spica casting protects the surgically repaired thumb UCL but risks placing additional stress upon adjacent joints and causing adjacent injury [41]. In the bone suture anchor cohort, one patient reported not returning to his usual performance [145]. Long-term dangers and the cost effectiveness of the Fiji Anchor® procedure are not known yet [63].

Recovery

Functional Outcomes and Patient-Reported Measures: In patients undergoing chronic UCL reconstructions, pinch strength showed no significant change, while grip strength, flexion, extension, ulnar deviation, and radial deviation demonstrated significantly better results [28]. Following acute surgical repair of the ruptured ulnar collateral ligament, recovery of pinch grip strength measured using two-point palmar pinch averages within 92 per cent of expected values after normalization for dominance [38]. Patients who subjectively perceive weakened pinch grip exhibit near-normal function on objective measurement [38]. Statistically significant weakness affecting tip pinch following repair may result from the test's sensitivity to small alterations in wrist position, which makes it difficult to elicit reliably [38]. In a study of acute surgical repair, all patients achieved a stable thumb with good range of movement [38]. All patients in this cohort were satisfied with the results and returned to former activities, including sport [38].

Return to Sport and Athletic Performance: There is a high rate of return to sport in the NFL following thumb UCL surgery [58]. Collegiate football athletes treated for thumb UCL injuries with suture anchor repair experienced quick return to play, reliable return to the same level of activity, and excellent long-term clinical outcomes [56]. Similarly, collegiate football athletes treated with dual suture anchor repair demonstrated quick return to play, reliable return to the same level of play, and excellent long-term clinical outcomes [57].

Rehabilitation Protocols and Biomechanical Safety: An accelerated rehabilitation protocol in athletes following thumb MCP UCL repair has been clinically applied [83].

Key Evidence

  • [L4] It could be an alternative treatment technique for thumb UCL avulsion fractures. [1] (10.1016/j.otsr.2019.01.008)
  • [L5] SutureTape augmentation has been shown in biomechanical studies of other hand ligaments such as the thumb UCL to greatly increase the load to failure, allowing patients to initiate early range of motion after surgery. [2] (10.1016/j.jhsg.2026.101050)
  • [L1] Surgical management of thumb UCL injuries produces overall favorable results. [3] (10.5435/jaaosglobal-d-25-00082)
  • [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] 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. [5] (10.1177/2325967117747268)
  • [L5] Untreated ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal joint can lead to long-term pain and functional limitations. [6] (10.2106/jbjs.k.01024)
  • [Paper] Transection of the UCL complex did not significantly alter the position of the proximal phalanx relative to the metacarpal of the thumb. [7] (10.1067/jhsu.2000.jhsu25a0313)
  • [L5] 75% of cases with complete rupture of the ulnar collateral ligament of the thumb will fail to heal with conservative treatment. [8] (10.1007/s11552-008-9145-8)
  • [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. [9] (10.1016/j.jhsa.2004.04.017)
  • [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)
  • [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. [11] (10.1016/j.jhsg.2022.02.008)
  • [L4] Thumb UCL repair with suture tape augmentation demonstrates short-term outcomes comparable to what has been reported for other methods of repair. [12] (10.1142/s2424835520500046)
  • [L3] The rate of surgery for acute thumb MP UCL injury varies based on patient characteristics and the individual treating surgeon. [13] (10.1177/1558944716681974)
  • [L5] No static ligament reconstruction restores the normal stability characteristics of the thumb UCL. [14] (10.1016/j.jhsa.2004.09.012)
  • [L5] The authors have used the described dorsal approach with safety and convenience over a several year period for repair and reconstruction of both the ulnar and radial collateral ligaments at the thumb metacarpophalangeal joint. [15] (10.1097/00130911-200403000-00003)
  • [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. [17] (10.1016/s0363-5023(97)80113-x)
  • [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. [18] (10.1016/j.jhsg.2023.03.005)
  • [L5] Sequential tearing of the thumb UCL leads to progressive instability of the MCP joint. [19] (10.1177/1558944719868518)
  • [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. [21] (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. [22] (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. [23] (10.1148/rg.264055117)
  • [L4] [24] (10.1177/1753193420932496)
  • [L4] MRI evaluation reveals greater details enabling better understanding and management of ulnar collateral ligament injuries of the thumb MCP joint. [25] (10.1016/s0363-5023(09)60139-8)
  • [L4] Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft. [26] (10.1016/j.jhsa.2024.05.005)
  • [L3] Both repair methods are safe and effective for treating thumb ulnar collateral ligament injuries. [27] (10.1097/prs.0b013e3181882163)
  • [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. [28] (10.1016/j.hansur.2020.03.002)
  • [L4] [30] (10.1142/s2424835519500176)
  • [L4] [31] (10.1016/j.jhsa.2024.12.003)
  • [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. [32] (10.1007/s11552-013-9500-2)
  • [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. [33] (10.1016/j.jhsa.2014.08.033)
  • [L5] Complications are rare and most patients show preservation of motion, key pinch, and grip strength. [35] (10.1016/j.ocl.2014.11.007)
  • [L5] Single- and double-bundle UCL reconstructions of the thumb MCP joint have comparable biomechanical properties in regard to joint congruity under valgus load. [36] (10.1177/1558944717744338)
  • [L4] [38] (10.1016/0020-1383(94)90179-1)
  • [L4] The methods adopted in the treatment of fresh ruptures of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb have been good. [39] (10.1016/s0020-1383(70)80123-1)
  • [L4] A method of reconstruction of the long standing rupture of ulnar collateral ligament of the thumb is described. [40] (10.1016/s0266-7681(85)80035-8)
  • [L4] Thumb spica casting protects the surgically repaired thumb UCL and allows for earlier return to play, but risks placing additional stress upon adjacent joints and causing adjacent injury. [41] (10.1177/1558944718788644)
  • [L3] MCP joint instability is a suitable indicator for surgical treatment in patients with thumb UCL avulsion fracture injuries. [42] (10.1177/15589447241308608)
  • [L5] [45] (10.1016/j.hcl.2012.05.024)
  • [L3] [46] (10.1177/15589447251338586)
  • [L5] [50] (10.1177/17531934241311826)
  • [L4] [51] (10.1016/j.main.2014.10.003)
  • [L5] Diagnosis of incompetence of the UCL of the MCP joint of the thumb remains a clinical rather than a radiographic diagnosis. [53] (10.1016/s0363-5023(98)80158-5)
  • [L4] This may suggest that a flat thumb metacarpal head is not associated with a traumatic thumb ulnar collateral ligament tear. [54] (10.1016/j.jhsa.2025.02.017)
  • [L5] The functional results of operative treatment are excellent, resulting in a stable and painless thumb in the vast majority of cases. [55] (10.5435/00124635-199707000-00006)
  • [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. [56] (10.1016/j.jhsa.2014.06.132)
  • [L4] Collegiate football athletes treated for thumb UCL injuries with dual suture anchor repair have quick return to play, reliable return to the same level of play and excellent long-term clinical outcomes. [57] (10.1177/2325967114s00092)
  • [L4] There is a high rate of return to sport in the NFL following thumb UCL surgery. [58] (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. [59] (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. [60] (10.1055/s-0040-1710154)
  • [L4] [62] (10.1007/s00402-026-06430-0)
  • [Paper] The surgical treatment of an ulnar collateral ligament lesion of the thumb using the Fiji Anchor® can lead to an excellent clinical outcome with a minor complication rate; however, long-term dangers and the cost effectiveness of the procedure are not known yet. [63] (10.1007/s00402-020-03625-x)
  • [L5] Supplemental thumb MP pin fixation more effectively protects the UCL from valgus strain compared to splinting alone. [66] (10.1007/s11552-015-9747-x)
  • [L4] This is the first clinical application of an accelerated rehabilitation protocol in athletes following thumb MCP UCL repair. [83] (10.1016/j.jht.2022.07.007)
  • [L4] [85] (10.1177/1753193408100957)
  • [L5] [86] (10.1097/00130911-200209000-00006)
  • [L5] [88] (10.1016/j.eats.2025.103957)
  • [L5] [90] (10.1016/j.jhsa.2008.09.025)
  • [L5] [91] (10.1186/1865-1380-6-31)
  • [L4] [105] (10.1016/s0363-5023(05)80156-x)
  • [L5] The dorsal fibrocartilage acts as a secondary stabilizer of the thumb MCP joint, working in tandem with the radial collateral ligament. [121] (10.1016/j.jhsa.2017.06.102)
  • [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. [126] (10.1016/j.jhsa.2024.01.008)
  • [L5] This study demonstrates that nonanatomic reconstruction of the UCL alters normal MCP joint range of motion. [131] (10.1053/jhsu.1999.0283)
  • [L5] Nonoperative treatment of partial ligament injuries with cast or splint immobilization will result in a stable and painless thumb. [133] (10.5435/00124635-201105000-00006)
  • [L4] [134] (10.1054/jhsb.2002.0838)
  • [L5] [135] (10.1177/1558944716661999)
  • [L5] [137] (10.1016/j.hcl.2009.05.014)
  • [L4] Magnetic resonance imaging was helpful in diagnosing a displaced ulnar collateral ligament in two cases and an intraligamentous injury in the other. [140] (10.1016/0363-5023(89)90203-7)
  • [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. [142] (10.1016/j.jhsa.2015.11.016)
  • [L5] The various methods of surgical treatment yield excellent outcomes with a low incidence of complications. [143] (10.5435/jaaos-d-22-00112)
  • [L4] [144] (10.1016/j.jhsg.2020.10.002)
  • [L4] [145] (10.1177/1753193417751802)
  • [L5] Thumb UCL repair with suture tape augmentation is able to restore varusevalgus kinematics after complete UCL tear without over-constraining the joint. [146] (10.1016/j.jhsa.2019.09.005)
  • [L4] [147] (10.1177/17531934231182895)
  • [L4] Ultrasonography is not adequate for identifying dislocated ulnar collateral ligaments of the metacarpophalangeal joint of the thumb. [148] (10.1080/02844319950159307)
  • [L3] Arthroscopic repair of thumb metacarpophalangeal injuries enables a precise ligamentous diagnosis. [149] (10.1016/j.main.2015.10.042)
  • [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. [152] (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. [153] (10.1016/j.jhsa.2018.11.012)
  • [L4] Augmenting the repair with anchored suture may prevent prolonged immobilization, expedite thumb motion, and improve postoperative recovery. [154] (10.1177/2325967120935063)

See Also

References

[1] 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

[2] Use of Internal Brace for the Surgical Management of the “Baby Stener” Lesion of the Radial Collateral Ligament to the Small Finger. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101050

[3] 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

[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] 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

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

[7] The effects of transection and reconstruction of the ulnar collateral ligament complex on the position of the proximal phalanx of the thumb during simulated tip pinch. The Journal of Hand Surgery. 2000. DOI: 10.1067/jhsu.2000.jhsu25a0313

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

[9] 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

[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] 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

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

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

[14] 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

[15] Surgical Approaches to the Metacarpophalangeal Joint of the Thumb for Repair and Reconstruction of the Collateral Ligaments and Capsule. Techniques in Hand and Upper Extremity Surgery. 2004. DOI: 10.1097/00130911-200403000-00003

[17] 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

[18] 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

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

[21] 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

[22] 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

[23] 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

[24] The value of magnetic resonance imaging and ultrasound in diagnosing displaced rupture of the thumb ulnar collateral ligament. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420932496

[25] 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

[26] 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

[27] 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

[28] 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

[30] Efficacy of Primary Repair in Professional Athletes with Chronic Radial Collateral Ligament Injuries of Thumb Metacarpophalangeal Joint. The Journal of Hand Surgery (Asian-Pacific Volume). 2019. DOI: 10.1142/s2424835519500176

[31] 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

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

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

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

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

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

[39] Surgical treatment of ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. Injury. 1970. DOI: 10.1016/s0020-1383(70)80123-1

[40] Ulnar Instability of The Metacarpophalangeal Joint of Thumb. Journal of Hand Surgery. 1985. DOI: 10.1016/s0266-7681(85)80035-8

[41] Early Return to Play With Thumb Spica Gauntlet Casting for Ulnar Collateral Ligament Injuries Complicated by Adjacent Joint Dislocations in Collegiate Football Linemen. HAND. 2018. DOI: 10.1177/1558944718788644

[42] A Morphologic Analysis of Thumb Ulnar Collateral Ligament Avulsion Fracture Fragments and Risk Factors for Surgical Treatment. HAND. 2024. DOI: 10.1177/15589447241308608

[45] Thumb Metacarpophalangeal Joint Collateral Ligament Injury Management. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.024

[46] Thumb Radial Collateral Ligament Injuries Show Greater Rates of Metacarpophalangeal Subluxation Compared With Thumb Ulnar Collateral Ligament Injuries: A Comparative Imaging Analysis. HAND. 2025. DOI: 10.1177/15589447251338586

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

[50] 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

[51] 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

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

[54] The Association of Metacarpal Head Morphology with Risk of Ulnar Collateral Ligament Rupture. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.02.017

[55] 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

[56] 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

[57] Return to Play and Long-Term Clinical Outcomes after Suture Anchor Repair of Thumb Ulnar Collateral Ligament Injuries in Collegiate Football Athletes. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00092

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

[59] 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

[60] 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

[62] Comprehensive ultrasound assessment of thumb metacarpophalangeal collateral ligament injuries reveals frequent concomitant abnormalities. Archives of Orthopaedic and Trauma Surgery. 2026. DOI: 10.1007/s00402-026-06430-0

[63] Clinical results of the BoneWelding®Fiji® anchor for the treatment of Stener lesions of the thumb. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03625-x

[66] Ulnar Collateral Ligament Strain of the Thumb Metacarpophalangeal Joint: Biomechanical Comparison of Two Postoperative Immobilization Techniques. HAND. 2015. DOI: 10.1007/s11552-015-9747-x

[68] Exam Of The Hand Wrist 2Ed. INTRODUCTION.

[72] Exam Of The Hand Wrist 2Ed. Planning skin cover of the hand and forearm.

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

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

[78] Exam Of The Hand Wrist 2Ed. 1.3 MOVEMENTS OF THE HAND AND WRIST > Gliding mechanisms.

[79] Exam Of The Hand Wrist 2Ed. The dorsal skin.

[80] Green S Operative Hand Surgery. PERTINENT ANATOMY.

[81] Exam Of The Hand Wrist 2Ed. The digital rays.

[83] 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

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

[86] Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Reconstruction Using a Tendon Graft. Techniques in Hand and Upper Extremity Surgery. 2002. DOI: 10.1097/00130911-200209000-00006

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

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

[91] Rupture of the ulnar collateral ligament of the thumb – a review. International Journal of Emergency Medicine. 2013. DOI: 10.1186/1865-1380-6-31

[105] 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

[121] Dorsoradial Instability of the Thumb Metacarpophalangeal Joint: A Biomechanical Investigation. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.102

[126] 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

[131] 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

[133] Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint. Journal of the American Academy of Orthopaedic Surgeons. 2011. DOI: 10.5435/00124635-201105000-00006

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

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

[137] Acute Ulnar Collateral Ligament Injury in the Athlete. Hand Clinics. 2009. DOI: 10.1016/j.hcl.2009.05.014

[140] Magnetic resonance imaging of the collateral ligaments of the thumb. The Journal of Hand Surgery. 1989. DOI: 10.1016/0363-5023(89)90203-7

[142] 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

[143] 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

[144] 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

[145] Mid- to long-term outcomes of collateral ligament repairs of 18 metacarpophalangeal joints with bone suture anchors. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193417751802

[146] 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

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

[148] 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

[149] Arthroscopic repair of thumb metacarpophalangeal ligament injuries – a prospective series. Chirurgie de la Main. 2015. DOI: 10.1016/j.main.2015.10.042

[152] 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

[153] 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

[154] Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120935063

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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.

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