Outcomes of modified trapeziectomy with ligament reconstruction tendon interposition for the treatment of advanced thumb carpometacarpal arthritis: Two-year follow-up

Abstract

Numerous arthroplasty techniques had been reported for the treatment of thumb carpometacarpal (CMC) joint osteoarthritis. The purpose of our study is to evaluate long-term clinical and radiographic outcomes of patients who underwent modified trapeziectomy with ligament reconstruction tendon interposition (LRTI).Our retrospective study included 20 consecutive patients with advanced thumb CMC arthritis receiving modified trapeziectomy with LRTI (20 thumbs). For clinical evaluation, we assessed visual analogue scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) scores and Kapandji index. Additionally, the grip, pinch power and waist flexion power, radial and volar abduction angle were evaluated, As for radiologic evaluation, we just estimated height of the trapezial space.We took 2-year follow-up. All patients showed decreased VAS from 6.8 preoperatively to 1.4. Mean DASH and Kapandji scores were improved from 52.2 preoperatively to 21.6 and from 6.4 preoperatively to 7.4, respectively. Compared to preoperative range of motion (ROM) for radial abduction and volar abduction, both markedly increased at 2-year follow-up (from 61.2 to 80.1, from 60.6 to 78.3, respectively). Besides, mean power improved from 15.9 preoperatively to 21.7 kg at 2-year follow-up for grip power, from 1.9 preoperatively to 3.5 kg at 2-year follow-up for tip pinch; however, mean waist flexion power showed no significant change from 20.5 preoperatively to 19.7 kg at 2-year follow-up. Notably, there was no significant sinking in height of the trapezial space from 10.0 preoperatively to 9.6 mm at 2-year follow-up. NO case had a complication at final follow-up.Modified trapeziectomy with LRTI treating thumb CMC arthritis in Eaton stage III-IV had a satisfactory efficacy. This new procedure is able to provides enough support for thumb to prevents thumb sinking.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1

Hand X-ray showed that height of the trapezial space before surgery. Radiographic reference points for measurement of the height of the CMC space. Line (a) is the line projected through the radial articular surface of the index metacarpal the trapezium. Line (b) is the line tangent to the thumb metacarpal base and perpendicular to line (a). Line (c) is the line tangent to the distal extreme of the scaphoid and perpendicular to line (a). The distance between line (b) and line (c) is the height of the CMC space. CMC = carpometacarpal.

Figure 2

An incision is made at dorsal thumb metacarpal bone.

Figure 3

Expose trapezium and excised piecemeal.

Figure 4

Remove trapezium.

Figure 5

Cut flexor carpi radialis in half.

Figure 6

We passed one-half of flexor carpi radialis through the hole and tied with the other and sutured.

Figure 7

We sewed continuously and rolled flexor carpi radialis up.

Figure 8

We put flexor carpi radialis into room where trapezium located in.

Figure 9

Hand X-ray showed that height of the trapezial space at 2-year follow-up. Radiographic reference points for measurement of the height of the CMC space. Line (a) is the line projected through the radial articular surface of the index metacarpal the trapezium. Line (b) is the line tangent to the thumb metacarpal base and perpendicular to line (a). Line (c) is the line tangent to the distal extreme of the scaphoid and perpendicular to line (a). The distance between line (b) and line (c) is the height of the CMC space. CMC = carpometacarpal.