complications after ucl repair of thumb

I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Am J Sports Med. Gamekeeper's thumb. 16. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Accessibility Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. The authors report no funding or conflicts of interest. unstable when the thumb is used. 18. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. NR, not reported. Clipboard, Search History, and several other advanced features are temporarily unavailable. 17. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Acute gamekeeper's thumb. Clin Orthop Relat Res. The overall complication rate was 13.8% (11/80). Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. All authors independently performed the search. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.30 The stability of the MP joint derives from joint congruity, the true and accessory collateral ligaments, the volar plate, and the surrounding intrinsic muscles.31 The adductor pollicis supplies active support on the ulnar aspect, whereas the abductor pollicis brevis and flexor pollicis brevis provide dynamic stability on the radial border. Bookshelf Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). PMC three muscles provide deforming forces at the base of the thumb. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. There is currently no consensus on treatment of acute or chronic UCL injuries. 2009;61:623632. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Van Dommelen BA, Zvirbulis RA. Because patients can start moving the thumb within days, it also mitigates some of the negative consequences of prolonged immobilization, such as stiffness and muscle atrophy. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Ulnar Collateral Ligament Repair . Epub 2015 Sep 22. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 35. If your bone is broken, a pin will be used to put it in place. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). 1962;124:396411. Moher D, Liberati A, Tetzlaff J, et al.. the thumb. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Please enable scripts and reload this page. The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. Wong TC, Ip FK, Wu WC. Please try after some time. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). #Injury location reported only in 3 studies. 13. The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%. Please try again soon. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. UCLR case series that contained complications data were included. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Orthop J Sports Med. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. Sports Health. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Exercises: Gradually progress to competitive throwing and sports . There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. A systematic review of ulnar collateral ligament reconstruction techniques. These exercises may be directed by a physical or occupational therapist. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. 1993;21:800804. Fusetti C, Papaloizos M, Meyer H, et al.. An anatomic basis for treatment. Dr. Holt will talk to you about when it is safe to return to work. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. A score of 2 was assigned if the item was completely and accurately performed and reported. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. 1994;23:797804. No study compared different graft types or fixation techniques. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. In these patients, after failure of nonoperative treatment at anywhere from 1 month to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. 2021 Apr 15;3(2):e527-e533. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Arnold DM, Cooney WP, Wood MB. In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . You may search for similar articles that contain these same keywords or you may 15. Rupture and displacement of the. Complications after surgical treatment of UCL injury are rare. 2009;6:e1000097. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. There were 200 acute injuries and 93 chronic injuries. Your surgeon is the person best able to help you avoid any serious recovery problems. The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. 2000;16:345357. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Upper extremity injuries in snow skiers. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. The torn thumb ligament is repaired or reconstructed during surgery. The mean patient age was 37.8 years (14.0-78.1). If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. Epub 2019 Mar 21. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 2005;24:217221. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. J Hand Surg Am. [30] The stability of the MP joint derives from joint congruity, the true and accessory collateral ligaments, the volar plate, and the surrounding intrinsic muscles. 1. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. 2003;8:8185. 10. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Non-Fusion. This damage may lead to temporary or permanent numbness or weakness. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. modify the keyword list to augment your search. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Nonoperative treatment often failed, necessitating surgery. may email you for journal alerts and information, but is committed Epub 2014 Oct 22. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Bean CH, Tencer AF, Trumble TE. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. Am J Sports Med. The doctor won't know if the repair is . A score of 2 was assigned if the item was completely and accurately performed and reported. A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . J Hand Surg Glob Online. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.32 The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.17,34 Anywhere from 14% to 64% of UCL injuries have associated Stener lesions, which occur when the adductor aponeurosis is interposed between the ruptured end of the UCL and its site of proximal phalanx attachment.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.23,3638 Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. Throwing status reported in 4 studies. Ulnar collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. Thus, the true natural history is yet unknown. 2005;87:26322638. 31. Part II: treatment and complications. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. 3. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. Surgical treatment has been advocated for all avulsion fractures of the UCL, as the area of articular cartilage is always greater than the fragment size. Mitsionis GI, Varitimidis SE, Sotereanos GG. Am J Sports Med. [16] Despite these study limitations, this systematic review is strong in that it analyzes the largest number of studies and subjects in the literature managed with both nonoperative and operative means for acute and chronic UCL injury. SYMPTOMS: The thumb may be swollen, bruised and painful. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). Careers. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. Conclusion: Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. Educate the patient on anti edema management. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. If it is appropriate, then surgical consent probably happened before the surgery. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. Injuries to the PIP joint remain swollen for long periods of time. Clipboard, Search History, and several other advanced features are temporarily unavailable. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. The range of motion of the MP joint of the thumb following operative repair of the. Both purely ligamentous and bony avulsion injuries were included. 1995;18:11611165. A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. Mean subject age was 33.9 years. There is also significant performance bias, as there are multiple different methods of treatment, providers, graft, suture, and fixation types, as well as methods and duration of immobilization. Kaplan EB. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Continue to stretch before and after throwing . [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. Long-term results of ligament reconstruction. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Would you like email updates of new search results? When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. 1999;24:275282. Wolters Kluwer Health, Inc. and/or its subsidiaries. 8600 Rockville Pike J Bone Joint Surg Am. There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. The Orthopedic Journal of Sports Medicine. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. Downey DJ, Moneim MS, Omer GE Jr. official website and that any information you provide is encrypted Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Only prospective studies can determine this injury course. Mean study follow-up was 42.8 months. Am J Sports Med. I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. Most times, they won't know until they're in the surgery if the internal brace is appropriate. The .gov means its official. Am J Sports Med. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Posner MA, Retaillaud JL. Continuous variable data were reported as mean SDs from the mean. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 34. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Results: Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. Louis DS, Huebner JJ Jr, Hankin FM. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Thumb dominance reported in 8 studies (168 thumbs). Please confirm that you would like to log out of Medscape. Sixty nine (86.3%) patients had grade 3 tears. 32. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. PLoS Med. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Injury. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 1987;214:113120. Federal government websites often end in .gov or .mil. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. For example, it can be removed when performing . Various levels of pain, bruising, or edema may present at the site of damage. Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. 37. Systematic review and meta-analysis. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Infection is a rare complication of hand surgery. Mean subject age was 33.9 years. MCP fusion was performed . 1992;8:713732. Hand Surg. Surgical management of chronic, 42. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. They may even tear completely. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Studies that duplicated patient populations from the same authors were excluded. There is, however, agreement on the treatment goals for repair or reconstruction of the UCL, which are to obtain and maintain an anatomic reduction of the MP joint, reproduce the anatomic origin and the insertion of native ligament, ensure sufficient strength to allow early range of motion, and minimize donor site morbidity if autograft is used. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. 1999;24:7075. No study directly compared the different types of graft for UCL reconstruction.

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