Thumb Sprains: Thumb UCL Repair

Thumb Sprains: Thumb UCL Repair

This video will provide a surgical demonstration of thumb ulnar collateral ligament repair, or U C L repair, on a cadaveric specimen. The surgeon will repair the ligament using a suture. Another supplemental suture will provide additional support to the repair, and bone anchors will hold the suture to the bone.

In an anatomy review, the UCL connects the thumb bone to the metacarpal bone just below. It is important in stabilizing the thumb during pinching and grasping activities. An injury to this ligament is often called a skier’s thumb.

The surgeon will begin by making a curved incision to the inner side of the thumb, then, will carefully dissect the soft tissue, mindful of vital vessels and nerves. A soft-tissue retractor is placed in the incision. Here, a shiny white capsule of tissue is seen. Beneath this capsule is the ulnar collateral ligament of the thumb.

An incision will be made through this capsule, and the UCL will be identified. The capsule is also retracted with the other soft tissues to expose the ligament best. The ligament in this cadaver is intact. The surgeon recreates a tear in the same location where it is often seen.

A metal wire is placed into the thumb bone in the exact location where the ligament typically attaches. The wire keeps the trajectory for the incoming drill. Next, a hollow-bodied drill guide and tip will be placed over the wire. The surgeon will drill a hole for an incoming bone anchor.

Once the hole is drilled, a forked-tipped bone anchor loaded with 2 types of sutures will be introduced. The small blue suture will be used to repair the ligament, and the larger, flatter suture will provide supplemental support. The anchor and the 2 sutures are screwed into the recently made hole in the bone.

The thumb is bent slightly to mimic the normal position in which the ligament would attach. The anchor handle is removed, and the sutures and bone anchor are shown as secured in the bone. The small blue suture is now passed through the ligament and tied to repair the tear. The suture is tied securely in a knot to hold the ligament in place. The suture is cut. A separate suture is used to repair the torn edges further. The ligament is now repaired.

The remaining flat support suture is now used. A small incision is made over the metacarpal bone in preparation for placing another bone anchor. Just as before, a wire will be placed, followed by a drill, to make the small hole in the bone for the anchor. A forked-tipped bone anchor will be used to capture the flat support suture.

The suture is carefully tensioned across the 2 bones as it is screwed in place. The handle will be removed. Both the repaired ligament and the support suture are shown. The thumb is now supported and firmly secured. The tissue capsule and the incision will be sutured closed, and the patient will be placed in a splint. The surgery is now complete.