Return to duty after suture anchor repair of thumb metacarpophalangeal ulnar collateral ligament injuries in active duty soldiers.

OBJECTIVE

Thumb metacarpophalangeal (MCP) ulnar collateral ligament (UCL) injury, commonly referred to as "Skier's thumb," is traditionally considered a sports-related injury. However, military personnel are frequently exposed to activities that may generate similar valgus stress mechanisms. This study aimed to evaluate the clinical characteristics, injury mechanisms, and surgical outcomes of thumb MCP UCL injuries in a South Korean military referal hospital.

METHODS

A retrospective review was conducted on 35 active duty military personnel who underwent surgical treatment for acute or subacute thumb MCP UCL injuries between May 2022 and May 2025. Patients with associated avulsion fractures requiring Kirschner-wire fixation or chronic injuries requiring ligament reconstruction were excluded. Demographic characteristics, injury mechanisms, presence of Stener lesions, clinical outcomes, return-to-duty status, and postoperative complications were analyzed. Surgical repair was performed using a suture anchor technique.

RESULTS

The mean follow-up period was 12.0 months. Rifle-related injuries accounted for 60.0% of all cases and represented the most common injury mechanism. Stener lesions were identified in 18 patients (51.4%). At final follow-up, the mean Visual Analog Scale score was 0.5, the mean Quick Disabilities of the Arm, Shoulder and Hand score was 4.2, and the mean Kapandji opposition score was 9.1. All patients demonstrated a firm endpoint on clinical valgus stress examination at final follow-up. The mean return-to-duty time was 11.8 weeks, and 94.3% of patients returned to unrestricted military duty within 3 months after surgery. One superficial wound infection and three transient sensory disturbances were observed, all of which resolved without additional surgery.

CONCLUSION

In this surgical cohort of active-duty soldiers with thumb MCP UCL injuries, rifle-related injury was the most commonly documented injury mechanisms. Surgical repair using suture anchor fixation showed absence of residual clinical valgus instability, favorable functional outcomes, and a high rate of return to duty. Awareness of military-specific injury mechanisms may facilitate early diagnosis and appropriate treatment in active duty soldiers.

LEVEL OF STUDY: IV case series.