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Correspondence to Author: Francisco Hugo de Souza Melo, Pedro Henrique Oliveira Bastos, José Victor de Vasconcelos Coelho, Ismael Cleto Anselmo Lisboa  

Department of Orthopedics and Traumatology HGF – Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil.
Department of Orthopedics and Traumatology IJF – Instituto Doutor José Frota, Fortaleza, Ceará, Brazil.
Department of Orthopedics and Traumatology HGF – Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil.
Department of Orthopedics and Traumatology UFC – Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.

DOI: 10.52338/tjop.2026.5729

Abstract:

Background: Ulnar collateral ligament (UCL) injuries are clinically relevant in sports medicine because they may compromise joint stability, grip strength, pinch function, athletic performance, and return to sport. Although UCL injuries are frequently discussed in relation to the elbow, thumb metacarpophalangeal UCL injuries are particularly important in athletes involved in skiing, football, martial arts, wrestling, ball-handling sports, and contact activities.
Objective: This systematic review aimed to compare surgical and conservative treatment for UCL rupture in athletes, with emphasis on return to sport, time to return, pain, function, joint stability, performance after return, and complications.
Methods: A systematic review was conducted according to PRISMA recommendations. Searches were performed in PubMed, MEDLINE, LILACS, and ScienceDirect for studies published between January 2010 and April 2026. Eligible studies included athletes or sport-related populations with UCL injury, primarily involving the thumb metacarpophalangeal joint, and reporting surgical, conservative, diagnostic, functional, or return-to-sport outcomes. A total of 16 studies were included in the final qualitative synthesis. Data were synthesized qualitatively because of heterogeneity in anatomical site, study design, treatment strategy, rehabilitation protocols, and outcome definitions.
Results: The included evidence was predominantly composed of retrospective cohorts, diagnostic studies, technical reports, case series, and case reports. Surgical treatment showed favorable outcomes in complete, unstable, displaced, chronic, bilateral, or high-demand thumb UCL injuries, with high rates of joint stability, functional recovery, and return to sport. Conservative treatment appeared appropriate for stable partial injuries when joint stability was preserved and no displacement or Stener lesion was suspected. Diagnostic studies emphasized that clinical examination remains central to decision-making, while MRI, 3T MRI, and ultrasound may support diagnosis in equivocal or complex cases. Reported complications included stiffness, residual pain, neuroma, adhesions, tenolysis, overtensioning in augmentation procedures, and adverse events related to accelerated return-to-play protocols.
Conclusion: Surgical treatment appears to provide more predictable restoration of stability and return-to-sport outcomes in complete or unstable thumb UCL injuries in athletes, whereas conservative management remains appropriate for stable partial lesions. Current evidence is limited by heterogeneous designs, small samples, and few direct comparisons between operative and nonoperative strategies. Future prospective studies should standardize injury classification, rehabilitation protocols, and return-to-sport criteria.

Keywords: Athletic Injuries; Athletes; Thumb; Ulnar Collateral Ligament; Return to Sport.

Citation:

Dr.Francisco Hugo de Souza Melo, Operative Versus Nonoperative Management Of Ulnar Collateral Ligament Ruptures In Athletic Populations: A Systematic Review Of Clinical And Return-To-Sport Outcomes. The Journal of Orthopaedics 2026.