A Quantitative Evaluation of Thumb Function after Ulnar Collateral Repair and Reconstruction

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Abstract
Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint are common and have received considerable recent attention in the literature. Against this increased diagnostic awareness stand surgical repair results, which lack objective criteria. Results are usually confined to good, bad or indifferent. A follow-up series of acute primary repairs (< 2 wk) and late reconstructive repairs is presented. All follow-up intervals were > 6 mo. (mean, 23 mo.). Fifteen patients had primary repair; 23 patients had late reconstruction. The age range of the patients was 14-62 yr (mean, 28 yr). Of the primary repairs, 40% involved a fragment of bone. The 2 most common types of reconstruction, that using a free tendon graft and that of adductor advancement, are similarly compared. Results were evaluated using range of motion, pinch strength, radiographs and standard subjective criteria, and compared to the normal contralateral thumb. Primary repair achieved 92% of normal pinch strength and 84% of normal thumb motion. Both reconstructive techniques yielded adequate pinch strengths although the adductor advancement (85%) was greater than the free tendon graft (81%). Range of motion was significantly more restricted in the adductor group (65%) than in the free graft group (78%). Subjectively, 15% of patients complained of aching with use of the thumb, 8% complained of weakness and 2% of residual instability. Of the patients with the free graft, 11% complained of the increased bulk over the reconstructed area of their thumb. Complications included 1 rerupture of a primary repair at 10 wk requiring reconstruction, 1 failure of an adductor advancement secondary to pullout at 4 wk during a cast change, 1 patient with dyesthesias in the dorsal sensory nerve of the thumb that resolved and 1 patient with hypertrophic scarring at a palmaris longus graft site. Primary repair done in the first 2 wk stabilizes the ulnar side of the metacarpophalangeal joint of the thumb and more closely approaches the function of its contralateral thumb metacarpophalangeal joint. Both reconstructive techniques have specific advantages and both gave adequate functional results. Pinch strength from tendon graft and adductor advancement were similar but motion was better with the graft. Patients with vocations requiring maximum thumb function, e.g., professional baseball pitcher, may benefit from a combination of the above reconstructive procedures; these are presented.

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