Ulnar Collateral Ligament Reconstruction of Thumb Metacarpophalangeal Joint With Adductor Pollicis Tendon Using the Wide-Awake Approach.

Injuries to the ulnar collateral ligament (UCL) of the thumb are common and require prompt attention. Diagnostic findings and treatment options differ in acute and chronic injuries of the UCL. Pain and weakness of pinch and grip occur with chronic UCL instability. Various surgical techniques have been described for the treatment of chronic ligament insufficiency at the metacarpophalangeal (MCP) joint of the thumb. These include refashioning of the ligament from capsular remnants, dynamic tendon transfers, tendon advancement, free tendon grafts, and MCP joint fusion. Free tendon grafts offer a reliable method of reconstruction. Fixation is usually achieved by passing sutures through drill holes, using pull out wires, passing the tendon graft through bone tunnels or attaching the tendon graft to a staple. However, a simpler technique using a half-slip of the adjacent adductor pollicis tendon to stabilize the thumb MCP joint can be considered. We demonstrate a simple and effective surgical technique for reconstruction of the UCL at the thumb MCP joint for chronic injury of the ligament, using the adjacent adductor pollicis tendon under a wide-awake approach.