CPT® Code 29902

1. Indications

The procedure is indicated for the following conditions:

• Displaced Ulnar Collateral Ligament Injury This includes injuries where the UCL has been avulsed or torn, particularly in cases where the ligament is displaced and requires surgical intervention for proper alignment and healing.
• Stener Lesion A specific type of UCL injury characterized by the interposition of the thumb adductor's aponeurosis between the avulsed UCL and its insertion point, necessitating surgical reduction to restore function.
• Skier's Thumb A common term for UCL injuries that occur during skiing or similar activities, where the thumb is subjected to excessive stress or force.
• Gamekeeper's Thumb Refers to chronic UCL injuries that may result from repetitive stress, often seen in individuals engaged in activities that require gripping or pinching.

2. Procedure

The surgical procedure involves several key steps to ensure effective treatment of the UCL injury:

• Step 1: Application of Finger Trap and Traction A finger trap is applied to the thumb to create traction, which helps in visualizing and accessing the joint more effectively during the procedure.
• Step 2: Portal Incision Creation Two portal incisions are made over the metacarpophalangeal joint, specifically at the dorsal-ulnar and dorsal-radial aspects, to provide access for the arthroscopic instruments.
• Step 3: Blunt Dissection Using a small hemostat, blunt dissection is performed to reach the joint capsule, allowing for the safe entry into the joint space.
• Step 4: Joint Inspection The arthroscope is introduced through the dorsal-radial portal, enabling the surgeon to inspect the joint for any damage or debris that may need to be addressed.
• Step 5: Removal of Hematoma and Bone Fragments A motorized shaver is utilized to remove any hematoma or bone fragments present in the joint, ensuring a clear surgical field.
• Step 6: Synovectomy The synovium is excised to allow for better visualization and identification of the UCL injury, facilitating the subsequent repair process.
• Step 7: Retrieval and Reduction of UCL A probe is inserted through the ulnar portal to retrieve the UCL, which is then reduced back to its anatomical position.
• Step 8: Fracture Site Debridement A shaver is introduced to debride the fracture site, preparing it for stabilization.
• Step 9: K-wire Insertion A K-wire is placed into the joint just proximal to the bony fragment and attached to the UCL to secure it in place.
• Step 10: Securing the UCL The K-wire is then passed through the bony fragment and secured to the proximal phalanx using a K-wire driver, ensuring proper alignment.
• Step 11: Verification of Alignment The alignment of the UCL and bony fragment is verified both arthroscopically and radiographically to ensure proper positioning.
• Step 12: Joint Flushing The joint is flushed with saline to remove any remaining debris, ensuring a clean surgical site.
• Step 13: Closure of Portal Incisions Upon completion of the procedure, the arthroscope and surgical tools are removed, and the portal incisions are closed to promote healing.

3. Post-Procedure

After the procedure, patients can expect a recovery period that may involve immobilization of the thumb to allow for proper healing of the UCL. Pain management and rehabilitation exercises may be recommended to restore function and strength in the thumb. Follow-up appointments will be necessary to monitor the healing process and ensure that the UCL remains properly aligned. Patients should be advised on activity modifications to prevent re-injury during the recovery phase.