Therapeutic interventions for acute complete ruptures of the ulnar collateral ligament of the thumb: a systematic review

Abstract

Background: The aim of this study was to evaluate the effectiveness of interventions for acute complete rupture of the ulnar collateral ligament (UCL) of the thumb in adults. Methods: The following databases were searched: MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO, from database inception to 31 st January 2018. Inclusion criteria were: (i) randomised controlled clinical trials (RCTs) or study of intervention with a comparator; (ii) participants with diagnosis of acute complete rupture of the UCL of the thumb; (iii) participants aged 18 years of age or older at enrolment; and (iv) published in a peer-reviewed English-language journal. Results: In total, six studies were identified for inclusion after screening. All studies had a high risk of bias. Three studies were retrospective comparative case series which compared two different surgical techniques (bone anchor versus pull out suture, suture versus pull out suture, suture versus steel wire). Of these studies, three were RCTs, two of which compared different rehabilitation regimes in patients managed surgically (plaster versus early mobilization, new spica versus standard spica). The remaining RCT compared two different rehabilitation regimes in a mixed group of surgically/non-surgically treated patients. The RCT comparing a standard spica with a new spica demonstrated a statistically significant improvement in outcomes with the new spica at all time points (range of motion, Dreiser index and VAS); this was also the only study to provide sufficient outcome data for further analysis. Conclusion: There is no prospective evidence comparing surgery to non-operative treatment for acute complete ruptures of the ulnar collateral ligament of the thumb. There is weak evidence to suggest that early mobilisation may be beneficial following surgical repair. Further research is necessary to better define which patients benefit from which specific interventions.

Inconsistencies are common between non-Cochrane systematic reviews and their protocols registered in the International prospective register of systematic reviews (PROSPERO) but were seldom explained

“…Furthermore, key information errors were found in two review protocols, confusing the exposure and outcome subgroup leading to a lack of clarity [24,27]. Other errors were discovered including the fact that protocols did not provide the details of the search strategy, despite the fact that the published review [34] stated explicitly that the detailed search strategy could be found in the protocol.…”

Diagnostic accuracy of ultrasound and magnetic resonance imaging in detecting Stener lesions of the thumb: systematic review and meta-analysis

“…Termed the 'quasi- Stener' by Milner et al (2015) the study demonstrated that 90% of these injuries fail conservative management and require surgical repair (Milner et al, 2015). Interestingly, a recent systematic review from our institution has shown limited evidence and consensus on the treatment of full-thickness UCL injuries (Mikhail et al, 2018). Further research is required to determine if specific imaging features on MRI could play a role in therapeutic stratification, beyond the position of the torn UCL relative to the aponeurosis.…”

Acute Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury: Diagnosis, Management, and Return to Sports Considerations

“…Complete tears without an associated Stener lesion or associated avulsion fractures represent more of a gray area (35,38,39). In a recent systematic review, no prospective studies comparing outcomes of nonoperative treatment to surgery for complete tears could be found (40).…”