What's the difference between repairing or reconstructing a torn ligament in the thumb? How does the surgeon decide which type of operation is needed?

Most often the decision to repair or reconstruct a torn ligament depends on the condition of the soft tissues when the area is opened surgically. The surgeon looks at the torn tissue and measures the thickness.

If the surgeon can find the ligament and pull it back to its attachment point on the bone then a repair is done. The ligament is sewn back in place. If the ligament was torn off with a little piece of bone still attached then an anchor or a suture that looks like a button is used to hold the bone in place until it heals.

If the ligament is old, fibrotic, and scarred, then the surgeon must start over. This is called reconstruction. The old tissue is removed. Holes are made in the bone. A tendon graft is harvested from some other place on the body and threaded through the holes. The graft is stitched in place. Sometimes a wire is used to hold the joint stable.

Whether repaired or reconstructed the patient is put in a cast for five or six weeks. Hand therapy follows cast removal to help you regain strength and motion.