Thumb Ulnar Collateral Ligament (UCL) Repair
Thumb ulnar collateral ligament (UCL) repair is a surgical procedure performed to treat injuries or instability of the thumb's metacarpophalangeal joint (MCPJ). The UCL plays a crucial role in providing stability to the thumb during pinch grip activities, such as holding objects between the thumb and fingers, like using a key.
When the UCL is injured or torn, it can lead to pain, weakness, and limited function of the thumb. UCL repair aims to restore strength and stability to the joint, allowing patients to regain full use of their thumb for functional hand movements.
Indications
Thumb UCL repair is indicated for individuals with the following conditions:
Acute Injuries (Skier’s Thumb)
Thumb UCL tears often occur from sudden forced abduction of the thumb, such as falling while holding a ski pole. Complete ruptures can leave the joint unstable, making it difficult to pinch or grip. In cases where the ligament has completely torn, displaced bone fragments are present, or a Stener lesion prevents natural healing, surgical repair is usually required.
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Complete ruptures with instability
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Stener lesion or displaced bone fragment
Chronic Instability
Some patients develop long-standing instability when acute tears are not treated properly. Over time, the thumb becomes weak during pinch or grip, leading to pain and reduced function. For these chronic cases, reconstruction rather than simple repair is often necessary to restore stability.
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Neglected tears with persistent instability
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Reconstruction needed when repair is not possible
Technique
The technique for Thumb UCL repair may vary based on the nature and timing of the injury.
Acute Cases
In fresh injuries, surgeons aim to restore the ligament to its original footprint. This can be achieved with transosseous sutures, suture anchors, or modern methods such as the InternalBrace™. Each technique provides secure fixation, with InternalBrace sometimes allowing earlier motion under supervision. Anchorless methods are also available when bone quality or fragment size limits anchor placement.
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Repair with sutures, anchors, or InternalBrace
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Anchorless methods in select cases
Chronic Cases
When the ligament has been torn for months, direct repair is rarely possible. In these cases, a tendon graft is harvested from the patient’s wrist or forearm and shaped into a new ligament. This procedure restores joint stability and allows patients to regain functional use of the thumb, even in long-standing cases.
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Tendon graft reconstruction (e.g., palmaris longus, EPB)
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Used when direct repair cannot be performed
Post-surgery rehabilitation
Post-surgery rehabilitation is a crucial aspect of the recovery process and focuses on restoring strength and mobility to the thumb.
After surgery, the thumb is protected in a spica splint to allow healing. For most patients, immobilisation lasts about four weeks. If InternalBrace is used, some protocols allow earlier gentle motion.
At four to six weeks, therapy begins with supervised range-of-motion exercises, followed by progressive strengthening.
By eight to twelve weeks, most patients regain stability and strength, with clearance for sports or heavy manual work once the surgeon confirms healing.
No. Partial tears often heal with splinting alone. Surgery is mainly required for complete tears, displaced fragments, or Stener lesions.
UCL Ligament Repair with Dr Oscar Brumby-Rendell
Dr Oscar Brumby-Rendell offers expert care in both acute and chronic UCL injuries. His approach combines precise surgical repair or reconstruction with proven rehabilitation procedure, helping patients return to pain-free daily function and sports.
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