Functional outcome of ligament reconstruction tendon interposition for basal joint arthritis of thumb
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20171890Keywords:
CMC joint arthritis, Basal joint arthritis, Ligament reconstruction, TrapeziectomyAbstract
Background: Thumb carpometacarpal osteoarthritis is a common disease, affecting up to 11% and 53% of men and women in their 50s respectively, which leads to pain, stiffness, weakness of the CMC joint. Patients with advanced disease have multiple surgical options including ligament reconstruction with tendon interposition, resection arthroplasty, silicone implantation, or total joint arthroplasty. The aim of study was to evaluate results of LRTI for CMC joint arthritis.
Methods: This is a series of 29 patients operated in a tertiary care hospital. All patients included in the study were seen in the outpatient and identified to have basal joint arthritis according to their clinical presentation and classified on the basis of radiologic appearance. Trapeziectomy with ligament reconstruction with tendon interposition was done for patients with advanced disease. All the patients were followed up and assessed for function and disability using DASH score.
Results: Average duration of follow up was 36 months with average tip pinch strength gain was 75%, key pinch strength gain 80% , grip strength gain 80 % of other limb. Significant Improvement in active 1st web space angle was seen with average of 19.5 degree. Average DASH score was 4.14. Nobody had extreme pain, 3 had mild pain and 2 had moderate pain.
Conclusions: Based on our observation of DASH scores, the results have remained encouraging in most of the cases with restoration of normal anatomy to provide a stable and functional thumb. The success of LRTI in treating trapeziometacarpal arthritis has withstood the test of time.
References
Armstrong AL, Hunter JB, Davis TRC. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg. 1994;19(3):340–1.
Vermeulen GM, Slijper H, Feitz R, Hovius SE, Moojen TM, Selles RW. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg. 2011;36(1):157–69.
Gervis WH. Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. J Bone Joint Surg Br. 1949;31(4):537–9.
Cavallazzi RM, Spreafico G. Trapezio-metacarpal arthrodesis today: why? J Hand Surg Br. 1986;11:250–4.
Hartigan BJ, Stern PJ, Kiefhaber TR. Thumb Carpometacarpal Osteoarthritis: Arthrodesis Compared with Ligament Reconstruction and Tendon Interposition. JBJS Am. 2001;83(10):1470-8.
Pellegrini VD Jr, Olcott CW, Hollenberg G. Contact patterns in the trapeziometacarpal joint: the role of the palmar beak ligament. J Hand Surg Am. 1993;18:238–44.
Burton RI, Pellegrini VD Jr. Surgical Management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am. 1986;11(3):324-32.
Eaton RG, Glickel SZ, Littler JW. Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb. J Hand Surg (Am). 1985;10:645–54.
Tomaino MM, Pellegrini VD, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am. 1995;77:346–55.
Conolly WB, Rath S. Revision procedures for complications of surgery for osteoarthritis of the carpometacarpal joint of the thumb. J Hand Surg (Br). 1993;18:533–9.
Damen A, van der Lei B, Robinson PH. Bilateral osteoarthritis of the trapeziometacarpal joint treated by bilateral tendon interposition arthroplasty. J Hand Surg (Br). 1997;22:96–9.
Kaarela O, Raatikainen T. Abductor pollicis longus tendon interposition arthroplasty for carpo-metacarpal osteoarthritis of the thumb. J Hand Surg. 1999;24:469–75.
