Efficacy of Primary Repair in Professional Athletes with Chronic Radial Collateral Ligament Injuries of Thumb Metacarpophalangeal Joint

Abstract

Background: Management of grade III injuries of the radial collateral ligament (RCL) of the thumb is controversial. These injuries are often treated with early surgery. However, early surgery may not be practical for the professional athlete. We report on the outcome of delayed primary repair of chronic RCL injuries without the use of tendon grafts or tendon transfers. Methods: Twelve elite professional athletes with 15 soft tissue RCL injuries who underwent delayed surgery (greater than 6 weeks) were included in this study. Athletes were managed with splinting and ongoing play during the sporting season, and underwent surgery at the conclusion of the season. Mean duration from injury to surgery was 5 months. Mean follow-up was 4.2 years after surgery. Patient-report outcome measures including pain, satisfaction rating, and disability of the arm, shoulder and hand (DASH) scores were collected. Examination findings including range of motion, laxity, and grip and pinch strength were also measured. Return-to-play data were collected for all athletes. Results: The RCL was able to be primarily repaired with suture anchors in all cases. All twelve patients were able to return to competitive play at the same pre-injury professional level. Post-operative joint function such as range of motion and laxity were comparable to the unaffected contralateral side, as were grip and lateral pinch strengths. Tip-pinch strength is lower compared to the unaffected side, but is comparable to age and sex-matched reference group. Conclusions: Delayed primary repair of the RCL is a viable option and results in satisfactory long-term outcomes. This option may be more preferable to the professional athlete who wishes to avoid surgery during the sporting season.

Finger Metacarpophalangeal Joint Injuries in Athletes: Evaluation, Diagnosis, Treatment, and Return to Play

“…Several authors have reported equivalent outcomes after surgical repair despite delayed treatment. 4,15,16 A systematic review of six studies reported excellent results in 80% of patients after autograft reconstruction, who were able to return to work with minimal disability. 9 Others have reported worsened outcomes in this setting, including decreased grip strength and persistent disability on postoperative disabilities of the arm, shoulder and hand (DASH) scores.…”

Overview of Sport-Specific Injuries

“…[58][59][60][61] Thumb ulnar collateral ligament injuries are very common, and are often seen in skiing, basketball, and football athletes. [62][63][64]…”

“…Acute hook of the hamate fractures can occur in golfers and baseball players; in the former, when striking the ground during the swing, and in the latter while checking a swing 58–61. Thumb ulnar collateral ligament injuries are very common, and are often seen in skiing, basketball, and football athletes 62–64…”