The aim of this study was to compare the results of complete thumb MCP ulnar collateral ligament rupture treated by repair using either suture anchors followed by early mobilization or a pull-out suture tied over a button with cast immobilization.
Thirty consecutive patients were treated in each cohort by the senior author and the results evaluated in a retrospective fashion. At final follow-up, the thumb MCP and IP range of motion was superior in the suture anchor group. No significant difference was noted between the groups for grip strength; however, pinch strength was more with the suture anchor group. Average tourniquet time for the anchor group was 28 minutes compared with 43 minutes for the button group. Twenty seven percent of the patients in the pull-out suture group suffered soft-tissue complications as compared with 7% in the suture anchor group. Cost analysis demonstrated a nearly $140-per-patient savings in the suture anchor cohort.
This study demonstrates that both methods yield acceptable results with relatively small yet statistically significant differences in outcomes that favor the use of suture anchors and early mobilization over pull-out sutures tied over a button with cast immobilization. An additional benefit of the suture anchor method is that it is less technically demanding than performing the repair with the pull-out suture tied over a button method, which may account for the 15 minute average difference in OR times. Limitations of the study include the retrospective nature as well as the difference in post-operative care. It may be that the superior results with the anchor group relate to earlier mobilization rather than the specific method of ligament reattachment.