THE TRANSOSSEUS PULL-OUT AND SUTURE ANCHOR REPAIRING TECHNIQUE IN THE TREATMENT OF ACUTE ULNAR COLLATERAL LIGAMENT INJURIES OF THE THUMB A COMPARISON OF TWO DIFFERENT SURGICAL APPROACHES

F. Rifino, F. Albano, T. Ladogana, A. Massari, M. Balducci, B. Moretti and G. Solarino

School of Medicine University of Bari “Aldo Moro” – AOU Consorziale – “Policlinico” – Department of Basic Medical Sciences; Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy

*Correspondence to:
Francesco Rifino, MD
School of Medicine, AOU Consorziale Policlinico,
Department of Basic Medical Sciences,
Neuroscience and Sense Organs,
Orthopaedic & Trauma Unit,
University of Bari Aldo Moro,
Piazza Giulio Cesare 11,
70124, Bari, Italy
e-mail: rifinofrancesco@gmail.com

Received: 25 April 2023 Accepted: 18 May  2023

ISSN: 1973-6401 Copyright © by Lab Publishers (2023) This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article.

ABSTRACT

Injury of the ulnar collateral ligament (UCL) of the thumb represents a common condition that has frequently been described in athletes like skiers but also may occur in other sports such as soccer, volleyball, basketball and rugby. Many treatment choices exist; it depends on the severity of injury, timing of presentation, patient’s comorbidity and associated soft tissue lesion. Grade I and II injuries may benefit from conservative treatment; a surgical approach is mandatory in case of a complete tear. The most used repair methods include the transosseous pull-out suture technique and reinsertion with a mini-anchor. This study aims to evaluate and compare the two surgical techniques in terms of functional and rehabilitative outcomes. From September 2020 to February 2022, 29 patients with a clinical and instrumental confirmed diagnosis of LCU injury of the thumb were recruited from the Orthopedics and Traumatology Unit of Policlinico of Bari. Sixteen patients underwent surgery with anchor repair; instead, 13 patients were treated with the pull-out technique. In the postoperative period, the patients were followed at first monthly, then at 6 months and at least 12 months. Sixteen patients (11 men, 5 women) underwent repair with an anchor; 13 patients (9 men, 4 women) underwent surgery with a pull-out technique. The anchor-treated cohort showed faster recovery of range of motion in flexion than the second group (P-value 0.046668). In contrast, no statistically significant difference was found in the extension recovery. At 6 months follow-up, the strange recovery was 94.4% for patients treated with anchors compared with 95.33% in patients operated with transosseous pull-out. The improvement of the pincer grip at 6 months in the anchor-treated cohort was 96.4%, while it was 94.96% in the other group. At least stability tests showed overlapping results. The two methods are found to be safe and effective for treating acute LCU injuries of the thumb. However, sutures with anchors allow earlier rehabilitation, which could eventually explain the better range of motion achieved by the patient treated with anchors 6 months after surgery compared with patients undergoing pull-out surgery. Despite the better functional and strength outcomes observed in the group of patients undergoing anchor repair, there is no significant difference between the two groups to justify the superiority of one technique over the other from a prognostic point of view.

KEYWORDS: ulnar collateral ligament, thumb, free tendon graft, rupture, avulsion fracture, surgery