Arthroscopic partial trapeziectomy and tendon interposition for thumb carpometacarpal arthritis

Abstract

BackgroundThe purpose of this study was to introduce arthroscopic partial trapeziectomy and tendon interposition for the treatment of symptomatic thumb carpometacarpal arthritis of Eaton stage II or III.MethodsFrom August 2001 to April 2009, 23 patients with thumb carpometacarpal arthritis were treated using this technique. Pain score, range of motion, and pinch strength were clinically evaluated and compared with the preoperative values after a minimum follow-up duration of 24 months.ResultsSignificant reduction in pain score and increases in range of motion and pinch strength were found (all p < 0.001) after a 2-year follow-up. The mean ± SD (median) postoperative pain score was 1.0 ± 0.7 (1.0) at rest and 1.3 ± 0.9 (1.0) during daily activities. The postoperative range of motion was 19.1° ± 4.2° (20°) for extension and 35.7° ± 7.1° (35.0°) for flexion, and the postoperative pinch strength was 86.5 % ± 19.9 % (90.0 %). No complications were observed in our patient series.ConclusionsArthroscopic partial trapeziectomy and soft tissue interposition could be an alternative treatment method for patients with symptomatic thumb carpometacarpal arthritis of Eaton stage II or III.

Arthroscopic Trapeziectomy and Suture Button Suspensionplasty: A Review of the Literature and Description of the “Three-Step Arthroscopic Trapeziectomy Technique”

“…Eaton classification, 4 whereas the latter can also be performed in stage IV cases. Many papers have described partial trapeziectomy, [5][6][7][8][9][10][11][12][13][14][15][16] but few have discussed complete trapeziectomy. 17,18 Numerous open surgery techniques, such as temporary Kirschner wire fixation, 19 soft tissue interpositions, 20 ligament reconstruction with or without tendon interposition, 21 and, more recently, suture button suspensionplasty (SBS), 22 have been developed to prevent proximal migration of the first metacarpal bone once the trapezium is removed.…”

Combination Therapy Involving Ear Cartilage Transfer and Suture-Button Suspension Arthroplasty for Symptomatic Thumb Carpometacarpal Joint Arthritis

“…Total trapeziectomy provided enough work space for suspension arthroplasty, whereas it decreased joint stability and thumb strength postoperatively. 4,[6][7][8] On the other hand, partial trapeziectomy maintained ligament and soft tissue around the scaphoid-trapezium-trapezoid (STT) joint, and the remaining trapezium supported the first metacarpal during grasping and pinching. 9 Indeed, the long-term outcomes after partial trapeziectomy resulted in sufficient relief of symptoms without decreased grip and pinch strengths.…”

“…12,13 Thus, the autologous tissue seems preferable. 4,8,11 For the autologous tissue for interposition, tendon (or tendon ball), 11 costal cartilage, 15 fascia lata, 16 and ear cartilage 4 have already been reported. The midterm effectiveness of ear cartilage interposition arthroplasty without ligament reconstruction was described by Nickell,4 who reported 53 thumbs in 49 patients over a 30month follow-up period, with good pain relief, Quick-DASH improvement, and stronger key-palm pinches.…”

Arthroscopic-Assisted Suspensionplasty Using the Palmaris Longus Tendon for Osteoarthritis of the Thumb Carpometacarpal Joint

“…Patients with Eaton stage IV scaphotrapeziotrapezoid osteoarthritis on plain radiographs are considered to be contraindicated for this technique. 8,9 The technique can also be used in patients who require additional treatment for first MCP joint hyperextension, such as a capsulodesis.…”