Thumb UCL Repair (Skier's / Gamekeeper's Thumb)

⚙️What This Procedure Involves

An incision is made over the ulnar side of the thumb MCP joint. The torn UCL is identified. In acute injuries: if the ligament has avulsed from bone with or without a fracture fragment, it is reattached using a suture anchor or small screw. A Stener lesion — where the torn ligament end has flipped over the adductor aponeurosis, preventing healing — is a specific indication for surgery because the interposed tissue blocks healing. In chronic injuries: the ligament is reconstructed using a tendon graft (palmaris longus or plantaris). The operation takes 45–75 minutes.

💡Why It May Be Recommended

Acute UCL repair is recommended for complete tears (especially with a Stener lesion), bony avulsions with displacement, and gross instability on stress testing. Partial tears may heal with splinting, but complete tears — particularly Stener lesions — do not heal without surgery.

⚖️Non-Operative Alternatives

Thumb spica splint for six weeks for partial tears and stable complete tears without Stener lesion. Hand therapy for rehabilitation.

📋Preparing for Surgery

X-rays to assess for bony avulsion. MRI or ultrasound to identify Stener lesion. Stress testing under local anaesthetic to assess stability. Surgery within two to three weeks of injury gives the best results.

✅Expected Benefits

Restoration of thumb stability and pinch grip strength. Acute repairs have excellent outcomes — over 90% return to full function. Chronic reconstructions have good but slightly less predictable outcomes.

⚠️Common Risks

• Thumb stiffnessCommon

  Some loss of MCP joint motion.

• Scar tendernessCommon

  Over the ulnar thumb.

• WeaknessCommon

  Mild residual weakness compared to the uninjured side.

🔴Less Common but Serious Risks

• Persistent instabilityUncommon

  The repair or reconstruction may fail.

• Digital nerve injuryUncommon

  The radial digital nerve of the index finger crosses the surgical field.

• InfectionRare

  Wound infection.

• ArthritisLong-term

  Post-traumatic MCP joint arthritis.

💉Anaesthetic Considerations

Local, regional, or general anaesthesia.

🏃Recovery and Rehabilitation

Thumb spica cast or splint for four to six weeks. Hand therapy for range of motion and pinch strengthening from six weeks. Return to sport at three months (with protective splint). Full recovery three to four months.

📅Follow-Up

X-ray at two weeks (if bony repair). Review at six weeks. Stress testing at three months to confirm stability.

❓Frequently Asked Questions