complications after ucl repair of thumb3 on 3 basketball tournaments in colorado

After significant delay to treatment or even failed nonoperative treatment, excellent clinical outcomes can be achieved, without a difference between initially treating the injury surgically. 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. 2021 Apr 15;3(2):e527-e533. FOIA 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. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. 1998;23:503506. Orthop J Sports Med. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. The torn thumb ligament is repaired or reconstructed during surgery. Stretching or even a rupture of the graft is also possible. Clinical Journal of Sport Medicine23(4):247-254, July 2013. Bean CH, Tencer AF, Trumble TE. In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. No study reported the outcomes of nonoperative management of chronic UCL injury. J Bone Joint Surg Am. Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. This leads to what is know as a positive ulnar variance. *Gender reported in 12 studies (218 subjects). Conclusion: Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. official website and that any information you provide is encrypted Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 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). 2018;6(4):1-7. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. You will receive email when new content is published. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Melone CP Jr, Beldner S, Basuk RS. 2022 Mar 1;30(1):e1-e8. Subject demographics are reported in Table 2. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. A common complication following fracture of the distal radius is when the radius shortens. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. 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. Keyword Highlighting Catalano LW III, Cardon L, Patenaude N, et al.. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. 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. It runs from the outer humerus, around the radial head and attaches to the ulna. 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). The overall complication rate was 13.8% (11/80). Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. Study data collected and analyzed included subject demographics, number and gender of the subjects, number of nonoperative thumbs, sidedness, dominance, subject age, subject weight, and body mass index, throwing athlete status, mean duration follow-up, UCL injury classification, location of UCL injury (proximal, midsubstance, or distal), number of subjects with Stener lesions, number of subjects with avulsion fractures, mechanism of injury, injury chronicity (defined by 3 weeks based on repair vs reconstruction treatment dichotomy proposed by Smith in 1977),17 length of symptoms, graft type used (autograft or allograft), and implant used. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Complications after surgical treatment of UCL injury are rare. The authors report no funding or conflicts of interest. Abstract. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. After failure of nonoperative treatment, at anywhere from 6 months 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation Epub 2016 Jan 13. 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. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Unable to load your collection due to an error, Unable to load your delegates due to an error. Various levels of pain, bruising, or edema may present at the site of damage. In some cases, certain risk factors make it more likely that a bone will fail to heal. Gamekeeper's thumb. They may even tear completely. Table 1. Am J Orthop (Belle Mead NJ). Sakellarides HT, DeWeese JW. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Management of thumb metacarpophalangeal ulnar collateral ligament injuries. 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. Riederer S, Nagy L, Buchler U. 1989;14:567573. Am J Sports Med. FOIA Nonoperative treatment often failed, necessitating surgery. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. eCollection 2021. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Bookshelf 6. 8. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. 23. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. Careers. three muscles provide deforming forces at the base of the thumb. 1976;58:106112. 15. and transmitted securely. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Rupture of the. The limitations of this systematic review are reliant on the studies analyzed. Thumb dominance reported in 8 studies (168 thumbs). 1,5,9,10 In acute cases of complete tears involving high-level . 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. 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. 18. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). eCollection 2022 May. 44. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Thumb sidedness reported in 3 studies (51 thumbs). Am J Sports Med. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. 8600 Rockville Pike the splint for protection or at night until twelve weeks after the operation. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. J Hand Surg Br. This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. 21. 25. Search performed on November 17, 2011. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Post-traumatic instability of the metacarpophalangeal joint of the thumb. 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. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. No study directly compared nonoperative to operative treatment. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Disclaimer. Kozin SH, Bishop AT. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. 2005;87:26322638. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. the thumb. Purpose. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Rupture and displacement of the. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. The injury involves the ulnar collateral ligament (UCL) of the thumb. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Meta-analysis of the pooled data was completed. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. 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. 2. Instability of the metacarpophalangeal joint of the thumb. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". A systematic review of multiple medical databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with specific inclusion and exclusion criteria. The anti edema management will continue for several weeks. Purpose: [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. sharing sensitive information, make sure youre on a federal unstable when the thumb is used. Ulnar Collateral Ligament Repair . Descriptive statistics were calculated. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. A sprained thumb is a common injury among athletes. Pichora DR, McMurtry RY, Bell MJ. According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The evidence regarding operative and nonoperative treatments of acute and chronic thumb UCL insufficiency is primarily limited to level IV retrospective case series and level V expert opinion. [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. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. For more information, please refer to our Privacy Policy. Epub 2015 Sep 22. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Arthrosc Sports Med Rehabil. Clipboard, Search History, and several other advanced features are temporarily unavailable. An anatomic basis for treatment. Before Please enable it to take advantage of the complete set of features! Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 8600 Rockville Pike MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Please try again soon. 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). Chir Main. better/same/worse than preoperative status). Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). eCollection 2021 Apr. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Unauthorized use of these marks is strictly prohibited. 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. 17. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. Epub 2014 Oct 22. 33. What Happens If We Sit for More Than 8 Hours Per Day? J Bone Joint Surg Am. 1996;25:527530. Abrahamsson SO, Sollerman C, Lundborg G, et al.. [15] In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.[15]. Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. The grip strength and the pinch strength were 94.3% and 92.27%,. Epub 2021 Sep 7. All rights reserved. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. Am J Sports Med. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. There were no cases of intraoperative ulnar nerve injury reported. This injury happens when an ulnar collateral ligament (UCL) tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Causes. Part I of this two-part article focuses on common tendon and . Data range was reported as minimum to maximum absolute values. Clin J Sport Med. The LUCL is located on the lateral or outside part of the elbow. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Acta Chir Scand. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Thumb collateral ligament injuries. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540). Unilateral injuries: 291 and bilateral injury: 1. Sports Med Arthrosc Rev. MeSH A score of 2 was assigned if the item was completely and accurately performed and reported. Hand Clin. J Bone Joint Surg Am. Sixty nine (86.3%) patients had grade 3 tears. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Am J Sports Med. A systematic review of multiple medical databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with specific inclusion and exclusion criteria. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. 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. Range of motion returns much sooner, too. 32. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. [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. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Van Dommelen BA, Zvirbulis RA. This site needs JavaScript to work properly. 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%. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Thirty-two thumbs were treated nonoperatively and 261 operatively. 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. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. You may also begin strengthening exercises if needed. For example, it can be removed when performing . If the latter was executed only partially, a score of 1 was assigned. HHS Vulnerability Disclosure, Help Your surgeon will discuss these options with you. sharing sensitive information, make sure youre on a federal 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. Please enter a Recipient Address and/or check the Send me a copy checkbox. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. [15,39] It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament. Tension wire fixation of avulsion fractures in the hand. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. 11. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Am J Orthop (Belle Mead NJ). Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. When assessed, most patients returned to their preinjury employment. A p-value of 0.05 was considered statistically significant. 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*.

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