Skeletal Radiology

, Volume 39, Issue 11, pp 1081–1086

MRI follow-up after free tendon graft reconstruction of the thumb ulnar collateral ligament

Scientific Article



Our aim was to analyse whether MRI is useful in the follow-up of reconstruction of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb, to describe normal postoperative findings, and to evaluate different MR sequences.

Material and Methods

Our study material consists of 10 patients who, because of a chronic rupture of the ulnar collateral ligament of the thumb, had been operatively treated using a free tendon graft. The patients were, in addition to the clinical examination and radiographs, also imaged using MRI both pre- and postoperatively. The postoperative MRI controls, undertaken at 2, 12 and 24 months were analysed without knowledge of the clinical or radiographic findings.


The reconstructed UCL was well visualised on MRI. One graft rupture was diagnosed on MRI and was later operatively confirmed. No increase in osteoarthritis of the metacarpophalangeal (MP) joint of the thumb was seen during the follow-up. The single most informative MR sequence was T2TSE in the coronal plane.


Magnetic resonance imaging may provide a clinically valuable means of assessing graft integrity in patients with suspected postoperative graft failure after UCL reconstruction, although we do not consider MRI necessary in the routine follow-up of patients with an uneventful recovery.


Magnetic resonance imaging Metacarpophalangeal joint Collateral ligament Surgery 


  1. 1.
    Diao E, Lintecum ND. Gamekeeper’s thumb. Curr Opin Orthop. 1996;7:10.Google Scholar
  2. 2.
    Van Dommelen BA, Zvirbulis RA. Upper extremity injuries in snow skiers. Am J Sports Med. 1989;17(6):751–3.CrossRefPubMedGoogle Scholar
  3. 3.
    Posner MA, Retaillaud JL. Metacarpophalangeal joint injuries of the thumb. Hand Clin. 1992;8(4):713–32.PubMedGoogle Scholar
  4. 4.
    Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpophalangeal joint of the thumb. A clinical and anatomical study. J Bone Joint Surg Br. 1962;44:869.Google Scholar
  5. 5.
    Drey GE, Eaton RG. In: Green D, editor. Dislocations and ligament injuries in the digits. New York: Churchill Livingstone; 1993.Google Scholar
  6. 6.
    Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg [Am]. 1984;9(5):692–99.Google Scholar
  7. 7.
    Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Jt Surg Am. 1973;55(8):1655–66.Google Scholar
  8. 8.
    Musharafieh RS, Bassim YR, Atiyeh BS. Ulnar collateral ligament rupture of the first metacarpophalangeal joint: a frequently missed injury in the emergency department. J Emerg Med. 1997;15(2):193–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Boyes J. Bunnell’s surgery of the hand. 5th ed. Philadelphia: Lippincott; 1970.Google Scholar
  10. 10.
    Joseph M, Fulkerson J, Nissen C, Sheehan TJ. Short-term recovery after anterior cruciate ligament reconstruction: a prospective comparison of three autografts. Orthopedics. 2006;29(3):243–8.PubMedGoogle Scholar
  11. 11.
    Agneskirchner JD, Galla M, Landwehr P, Lobenhoffer HP. Simplified MRI sequences for postoperative control of hamstring anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg. 2004;124(4):215–20.CrossRefPubMedGoogle Scholar
  12. 12.
    Hong SJ, Ahn JM, Ahn JH, Park SW. Postoperative MR findings of the healthy ACL grafts: correlation with second look arthroscopy. Clin Imaging. 2005;29(1):55–9.PubMedGoogle Scholar
  13. 13.
    Cossey AJ, Kalairajah Y, Morcom R, Spriggins AJ. Magnetic resonance imaging evaluation of biodegradable transfemoral fixation used in anterior cruciate ligament reconstruction. Arthroscopy. 2006;22(2):199–204.CrossRefPubMedGoogle Scholar
  14. 14.
    Chien AJ, Jacobson JA, Jamadar DA, Brigido MK, Femino JE, Hayes CW. Imaging appearances of lateral ankle ligament reconstruction. Radiographics. 2004;24(4):999–1008.CrossRefPubMedGoogle Scholar
  15. 15.
    Palmer AK, Louis DS. Assessing ulnar instability of the metacarpophalangeal joint of the thumb. J Hand Surg [Am]. 1978;3(6):542–6.Google Scholar
  16. 16.
    Downey Jr EF, Curtis DJ. Patient-induced stress test of the first metacarpophalangeal joint: a radiographic assessment of collateral ligament injuries. Radiology. 1986;158(3):679–83.PubMedGoogle Scholar
  17. 17.
    Bowers WH, Hurst LC. Gamekeeper’s thumb. Evaluation by arthrography and stress roentgenography. J Bone Joint Surg Am. 1977;59(4):519–24.PubMedGoogle Scholar
  18. 18.
    Stothard J, Caird DM. Experience with arthrography of the first metacarpophalangeal joint. Hand. 1981;13(3):257–66.CrossRefPubMedGoogle Scholar
  19. 19.
    Haramati N, Hiller N, Dowdle J, Jacobson M, Barax CN, Lieberfarb RI, et al. MRI of the Stener lesion. Skeletal Radiol. 1995;24(7):515–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Hergan K, Mittler C, Oser W. Ulnar collateral ligament: differentiation of displaced and nondisplaced tears with US and MR imaging. Radiology. 1995;194(1):65–71.PubMedGoogle Scholar
  21. 21.
    Hinke DH, Erickson SJ, Chamoy L, Timins ME. Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper’s thumb). AJR Am J Roentgenol. 1994;163(6):1431–4.PubMedGoogle Scholar
  22. 22.
    Spaeth HJ, Abrams RA, Bock GW, Trudell D, Hodler J, Botte MJ, et al. Gamekeeper thumb: differentiation of nondisplaced and displaced tears of the ulnar collateral ligament with MR imaging. Work in progress. Radiology. 1993;188(2):553–6.PubMedGoogle Scholar
  23. 23.
    Ahn JM, Sartoris DJ, Kang HS, Botte MJ, Trudell D, Haghighi P, et al. Gamekeeper thumb: comparison of MR arthrography with conventional arthrography and MR imaging in cadavers. Radiology. 1998;206(3):737–44.PubMedGoogle Scholar
  24. 24.
    Harper MT, Chandnani VP, Spaeth J, Santangelo JR, Providence BC, Bagg MA. Gamekeeper thumb: diagnosis of ulnar collateral ligament injury using magnetic resonance imaging, magnetic resonance arthrography and stress radiography. J Magn Reson Imaging. 1996;6(2):322–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Susic D, Hansen BR, Hansen TB. Ultrasonography may be misleading in the diagnosis of ruptured and dislocated ulnar collateral ligaments of the thumb. Scand J Plast Reconstr Surg Hand Surg. 1999;33(3):319–20.CrossRefPubMedGoogle Scholar
  26. 26.
    Watson-Jones R. Fractures and joint injuries. 3rd ed. Edinburgh: E & S Livingston; 1943.Google Scholar
  27. 27.
    Helm RH. Hand function after injuries to the collateral ligaments of the metacarpophalangeal joint of the thumb. J Hand Surg [Br]. 1987;12(2):252–5.Google Scholar

Copyright information

© ISS 2010

Authors and Affiliations

  • M. Lohman
    • 1
  • J. Vasenius
    • 2
  • O. Nieminen
    • 3
  • L. Kivisaari
    • 1
  1. 1.Department of RadiologyHelsinki University HospitalHelsinkiFinland
  2. 2.Department of Hand SurgeryDextra HospitalHelsinkiFinland
  3. 3.Department of Hand SurgeryHelsinki University HospitalHelsinkiFinland

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