Sexual dimorphism in the anatomy of the ulnar collateral thumb ligament

  • Martin F. VierhapperEmail author
  • Gabriela K. Muschitz
  • Stefan Hacker
  • Sandra E. Boesmueller
  • Michael Pretterklieber
  • Hugo B. Kitzinger
original article



Treatment of ruptured ulnar collateral thumb metacarpophalangeal (MCP) joint ligaments (UCL) necessitate a profound anatomic knowledge for optimal surgical repair in order to preserve range of motion and ensure postoperative joint stability. Therefore, knowledge of the angle between the UCL and the longitudinal axis of the first metacarpal bone could be useful.


In this study 46 ulnar collateral thumb MCP joint ligaments in 15 male and 15 female embalmed anatomic specimens were dissected and the angles between the longitudinal axis of the first metacarpal bone and the proper (PUCL) as well as the accessory ulnar collateral thumb MCP ligament (AUCL) were measured.


In male specimens the angle for the PUCL measured on average 133.5° (±2.35°) and 122.75° (±3.8°) for the AUCL. A significantly different angle was measured for female specimens which showed on average 137.88° (±3.51°) for the PUCL and 128.65° (±4.14°) for the AUCL.


Optimal surgical repair or reconstruction of torn ulnar collateral thumb MCP joint ligaments should aim for an angle of approximately 135° in PUCL and 126° in AUCL in relation to the longitudinal axis of the metacarpal bone. Differences in men and women should be considered if possible.

Level of evidence

IV (anatomic study).


Ulnar collateral ligament thumb Thumb metacarpophalangeal joint Anatomic sexual dimorphism Collateral ligament thumb 



The authors gratefully thank all donors who placed their bodies at disposal by last will and testament to the body donation program of this university. Without their gift anatomic research would not be possible.


None of the authors has a financial interest in any of the products or devices mentioned in this manuscript. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical guidelines

Conflict of interest

M.F. Vierhapper, G.K. Muschitz, S. Hacker, S.E. Boesmueller, M. Pretterklieber, and H.B. Kitzinger declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Fritsche E, De Monaco D, Drinkuth S, von Wartburg U. Simultaneous avulsion fracture of the insertion of the ulnar and radial collateral ligaments of the metacarpophalangeal joint of the thumb. Br J Plast Surg. 2000;53(2):168–70.CrossRefGoogle Scholar
  2. 2.
    Samora JB, Harris JD, Griesser MJ, Ruff ME, Awan HM. Outcomes after injury to the thumb ulnar collateral ligament—A systematic review. Clin J Sport Med. 2013;23(4):247–54.CrossRefGoogle Scholar
  3. 3.
    Bailie DS, Benson LS, Marymont JV. Proximal interphalangeal joint injuries of the hand. Part I: Anatomy and diagnosis. Am J Orthop. 1996;25(7):474–7.PubMedGoogle Scholar
  4. 4.
    Benson LS, Bailie DS. Proximal interphalangeal joint injuries of the hand. Part II: Treatment and complications. Am J Orthop. 1996;25(8):527–30.PubMedGoogle Scholar
  5. 5.
    Aldrian S, Valentin P, Wondrasch B, Krusche-Mandl I, Ostermann RC, Platzer P, et al. Gender differences following computer-navigated single- and double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2014;22(9):2145–52.CrossRefGoogle Scholar
  6. 6.
    Heyman P, Gelberman RH, Duncan K, Hipp JA. Injuries of the ulnar collateral ligament of the thumb metacarpophalangeal joint. Biomechanical and prospective clinical studies on the usefulness of valgus stress testing. Clin Orthop Relat Res. 1993;292:165–71.CrossRefGoogle Scholar
  7. 7.
    Minami A, An KN, Cooney WP 3rd, Linscheid RL, Chao EY. Ligamentous structures of the metacarpophalangeal joint: A quantitative anatomic study. J Orthop Res. 1984;1(4):361–8.CrossRefGoogle Scholar
  8. 8.
    Fraser B, Veitch J, Firoozbakhsh K. Assessment of rotational instability with disruption of the accessory collateral ligament of the thumb MCP joint: A biomechanical study. Hand. 2008;3(3):224–8.CrossRefGoogle Scholar
  9. 9.
    Carlson MG, Warner KK, Meyers KN, Hearns KA, Kok PL. Anatomy of the thumb metacarpophalangeal ulnar and radial collateral ligaments. J Hand Surg Am. 2012;37(10):2021–6.CrossRefGoogle Scholar
  10. 10.
    Tsiouri C, Hayton MJ, Baratz M. Injury to the ulnar collateral ligament of the thumb. Hand. 2009;4(1):12–8.CrossRefGoogle Scholar
  11. 11.
    Campbell CS. Gamekeeper’s thumb. J Bone Joint Surg Br. 1955; Scholar
  12. 12.
    Derkash RS, Matyas JR, Weaver JK, Oden RR, Kirk RE, Freeman JR, et al. Acute surgical repair of the skier’s thumb. Clin Orthop Relat Res. 1987;216:29–33.Google Scholar
  13. 13.
    Kaplan SJ. The Stener lesion revisited: A case report. J Hand Surg Am. 1998;23(5):833–6.CrossRefGoogle Scholar
  14. 14.
    Jones S, Crawford I. Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. Plaster or functional splint in gamekeepers thumb. Emerg Med J. 2002;19(4):324.CrossRefGoogle Scholar
  15. 15.
    Crowley TP, Stevenson S, Taghizadeh R, Addison P, Milner RH. Early active mobilization following UCL repair with Mitek bone anchor. Tech Hand Up Extrem Surg. 2013;17(3):124–7.PubMedGoogle Scholar
  16. 16.
    Gluck JS, Balutis EC, Glickel SZ. Thumb ligament injuries. J Hand Surg Am. 2015;40(4):835–42.CrossRefGoogle Scholar
  17. 17.
    Smith RJ. Post-traumatic instability of the metacarpophalangeal joint of the thumb. J Bone Joint Surg Am. 1977;59(1):14–21.CrossRefGoogle Scholar
  18. 18.
    Bean CH, Tencer AF, Trumble TE. The effect of thumb metacarpophalangeal ulnar collateral ligament attachment site on joint range of motion: An in vitro study. J Hand Surg Am. 1999;24(2):283–7.CrossRefGoogle Scholar
  19. 19.
    Baskies MA, Lee SK. Evaluation and treatment of injuries of the ulnar collateral ligament of the thumb metacarpophalangeal joint. Bull NYU Hosp Jt Dis. 2009;67(1):68–74.PubMedGoogle Scholar
  20. 20.
    Rhee PC, Jones DB, Kakar S. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. J Bone Joint Surg Am. 2012;94(21):2005–12.CrossRefGoogle Scholar
  21. 21.
    Carlson MG, Warner KK, Meyers KN, Hearns KA, Kok PL. Mechanics of an anatomical reconstruction for the thumb metacarpophalangeal collateral ligaments. J Hand Surg Am. 2013;38(1):117–23.CrossRefGoogle Scholar
  22. 22.
    Lee SK, Kubiak EN, Lawler E, Iesaka K, Liporace FA, Green SM. Thumb metacarpophalangeal ulnar collateral ligament injuries: A biomechanical simulation study of four static reconstructions. J Hand Surg Am. 2005;30(5):1056–60.CrossRefGoogle Scholar
  23. 23.
    Boesmueller S, Huf W, Rettl G, Dahm F, Meznik A, Muschitz G, et al. The influence of sex and trauma impact on the rupture site of the ulnar collateral ligament of the thumb. PLoS ONE. 2017;12(7):e181754.CrossRefGoogle Scholar
  24. 24.
    Deitch JR, Starkey C, Walters SL, Moseley JB. Injury risk in professional basketball players: A comparison of Women’s National Basketball Association and National Basketball Association athletes. Am J Sports Med. 2006;34(7):1077–83.CrossRefGoogle Scholar
  25. 25.
    Nordenvall R, Bahmanyar S, Adami J, Stenros C, Wredmark T, Fellander-Tsai L. A population-based nationwide study of cruciate ligament injury in Sweden, 2001–2009: Incidence, treatment, and sex differences. Am J Sports Med. 2012;40(8):1808–13.CrossRefGoogle Scholar
  26. 26.
    Ito E, Iwamoto J, Azuma K, Matsumoto H. Sex-specific differences in injury types among basketball players. Open Access J Sports Med. 2015;6:1–6.PubMedGoogle Scholar
  27. 27.
    Mountcastle SB, Posner M, Kragh JF Jr., Taylor DC. Gender differences in anterior cruciate ligament injury vary with activity: Epidemiology of anterior cruciate ligament injuries in a young, athletic population. Am J Sports Med. 2007;35(10):1635–42.CrossRefGoogle Scholar
  28. 28.
    Bere T, Florenes TW, Nordsletten L, Bahr R. Sex differences in the risk of injury in World Cup alpine skiers: A 6-year cohort study. Br J Sports Med. 2014;48(1):36–40.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Martin F. Vierhapper
    • 1
    Email author
  • Gabriela K. Muschitz
    • 2
  • Stefan Hacker
    • 3
  • Sandra E. Boesmueller
    • 4
  • Michael Pretterklieber
    • 5
  • Hugo B. Kitzinger
    • 6
  1. 1.Division of Plastic and Reconstructive Surgery, Department of SurgeryWilhelminenspital ViennaViennaAustria
  2. 2.ViennaAustria
  3. 3.Clinic for Facial Plastic Surgery, Marienhospital StuttgartStuttgartGermany
  4. 4.Department of Trauma Surgery, AUVA trauma hospital Meidling ViennaMedical University of ViennaViennaAustria
  5. 5.Center of Anatomy and Cell Biology, Department of Applied AnatomyMedical University of ViennaViennaAustria
  6. 6.ViennaAustria

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