• 
  
  Common in active population
  
  
• 
  
  Partial UCL tears can be treated nonsurgically in a cast for 4 weeks

Patient Selection

Indications for Surgery

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  Complete injury to the UCL as evidenced by instability to radial deviation stress testing with no firm end point
  

  
  
  • 
    
    >30° of deviation with radial stress
    
    
  • 
    
    >15° to 20° of deviation with radial stress compared with contralateral side
  
  
• 
  
  Stener lesion (adductor aponeurosis interposition blocking reduction of UCL)
  
  
• 
  
  Failure of nonsurgical management (Figures 1and 2) which can include continued pain or instability despite an adequate period of immobilization

Video 51.1 Radial Deviation Instability. Preoperative examination of a patient with ulnar collateral ligament injury demonstrating more than 30° radial deviation at MCP joint with radial stress. Blake K. Montgomery, MD; Jeffrey Yao, MD (5 s)

Contraindications

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  Articular cartilage changes or frank osteoarthritis of the MCP joint

Preoperative Imaging

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  Plain radiographs of thumb including three views to evaluate for subluxation, deformity, fracture, and arthritis
  
  
• 
  
  MRI if examiner unable to determine if UCL is completely torn
  
  
• 
  
  Stress radiographs compared with those of contralateral thumb

Procedure

Room Setup/Patient Positioning

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  Standard patient positioning with hand table with brachial tourniquet inflated to 250 mmHg
  
  
• 
  
  Regional, general, or local anesthesia

Special Instruments/Equipment

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  Sutures anchors of the surgeon’s choice should be available before the start of the procedure (size of anchor should be <3 mm)
  
  
• 
  
  Bone gouges, suture passer, and interference screw should be available in the event of the need for reconstruction

Surgical Technique

Approach and Dissection