Evolution of Technology

Ligament Repair with Reinforcement/ Augmentation

Ligament repair with reinforcement/ augmentation evolved as hand surgeons looked at ways to make the UCL stronger after surgery to repair or reconstruct it. If the post-surgical UCL is not strong enough, it can stretch out over time, allowing abnormal motion and pain to recur. When a weak UCL is subjected to sufficient force, the ligament can tear again and require further surgery. Having a stronger UCL allows patients to get back to higher levels of activity with their hands, even including physical labor and elite sports competition. The first thing surgeons look at is whether to repair the tissue that is already there, or whether to borrow a nearby tendon to achieve better quality and strength of the UCL. Beyond this decision, surgeons have started using synthetic material, placed alongside the tendon or ligament and secured with it to the bones, to make the post-surgical UCL stronger. A tendon or ligament must still be used to achieve bony healing, but something extra can be added to the UCL to make it stronger. This allows patients to move the joint and resume more activity sooner after surgery.

Evolution of Procedure

Thumb MCP Joint Ligament Surgery

Surgical treatment of Gamekeeper’s/ Skier’s thumb involves repair or replacement of the injured UCL ligament in the thumb MCP joint. If the tear is recent and the tissue allows, the ligament can be stitched back together. Often, a small anchor is placed into the bone to help secure the repaired ligament. If the tear is older and/ or the tissue is not of good quality at surgery, it may be necessary to reconstruct (make a new UCL) rather than repair the native ligament. A tendon from elsewhere in the hand or wrist can be borrowed and anchored into the bones above and below to create a new UCL that will help keep the MCP joint stable. Good outcomes after surgery depend on the repaired or reconstructed ligament staying intact and healing back to the bone. Suture anchors help with healing to the bone. For strength of the UCL after surgery, surgeons looked at ways to strengthen the tissue and this led to a new technique involving the addition of a strong suture material to the UCL to make it more resistant to failure.

Evolution of Diagnosis

Thumb Metacarpophalangeal (MCP) Joint Sprain (Gamekeeper’s/ Skier’s Thumb)

Gamekeeper’s/ Skier’s thumb is an injury to a particular ligament in the thumb at the level of the metacarpophalangeal (MCP) joint. The injured structure is the ulnar collateral ligament (UCL) on the inside part of the joint. This injury happens when the thumb is forcefully bent away from the UCL side of the joint, causing the ligament to strain and, eventually, tear. In current times, getting the thumb caught by a ski pole is a common way to injure the UCL. In the past, hunters suffered this injury on a chronic basis, due to repeatedly using their thumb and hand to break the necks of rabbits. When the UCL is injured, the MCP joint is no longer stable and starts to move abnormally with hand use. Symptoms of gamekeeper’s/ Skier’s thumb include swelling of the thumb (right after injury), pain with hand use, clicking or popping at the affected joint, abnormal movement of the affected joint. These symptoms can sometimes resolve after treatment in a cast or splint. However, when the tear is more severe, surgery may be required to fix the problem.