Dorsoradial Capsulodesis for Stage I Trapeziometacarpal Joint Arthrosis

Abstract

Background: Thumb trapeziometacarpal (TM) joint arthrosis is a common cause of thumb pain, which adversely affects hand function. Early arthrosis is characterized by capsular laxity, painful pinch and grip, and physical findings of joint tenderness and laxity. Dorsoradial capsulodesis (DRC) is a surgical technique used to stabilize the TM joint and treat early-stage arthrosis. We aim to evaluate the clinical outcomes of DRC for treating trapeziometacarpal instability in early-stage disease. Methods: Between 2003 and 2019, 23 patients underwent DRC. Patients with stage I TM arthritis and more than 6-month postoperative follow-up were included. Pain and disability scores were calculated along with physical examination and radiographic evaluation at the final follow-up. Results: At mean postoperative follow-up of 43.5 months, 13 patients with a mean age of 39.1 years were examined. The mean Disabilities of the Arm, Shoulder, and Hand score was 5.7, and visual analog pain score was 0.5. Patients had no significant difference in strength or range of motion in the ipsilateral versus contralateral hand. Follow-up radiographs did not demonstrate arthritic changes. Conclusions: Dorsoradial capsulodesis is a technically simple and reasonable option for stabilizing the TM joint in patients with early-stage arthrosis. This intervention showed no midterm progression to advanced arthritis in this cohort.

Ligament reconstruction in thumb carpometacarpal joint instability: A systematic review

“…Eight studies incorporated the VAS scores as part of their outcome measurements, and five studies reported the pre- and postoperative VAS scores ( Table 3 ). 7 , 34 , 37 , 36 , 40 , 42 , 43 The tendon-looping procedure using the PL tendon and TCL flap reported the most notable improvement in mean VAS scores, which improved from 6 (range 5–7) preoperatively to 0.5 (range 0–1) postoperatively. 40 Dorsal stabilization using an internal brace, 34 volar thermal capsulorrhaphy, 37 and the Eaton and Littler technique by Spekreijse et al.…”

“… 34 , 35 Eleven publications consisting of 12 studies that met the inclusion and exclusion criteria were analyzed for qualitative review, including one randomized controlled trial (RCT), 36 six before-after studies, 34 , 36 , 37 , 38 , 39 , 40 and five observational studies. 7 , 35 , 41 , 42 , 43 These articles reported a total of 216 patients, 230 thumbs, and 9 different surgical techniques ( Tables 1 and 2 ). The included studies reported the surgical outcomes with long-term follow-up ranging from 12 months to 15 years.…”

“…The included studies described surgical techniques that aimed to achieve stability of the thumb CMC joint either by reconstructing the affected ligaments using a tendon strip 7 , 35 , 36 , 38 , 39 , 40 , 41 , 43 or by reinforcing the joint capsule ( Table 2 ). 34 , 37 , 42 In the included studies, the Eaton and Littler technique was the most studied procedure. 7 , 26 , 38 , 39 Pecache and Tsai described a tendon looping technique similar to the volar ligament reconstruction, but the FCR strip was routed through a second bone tunnel in the trapezium and secured in a figure-of-eight fashion.…”

“…and Koehler and Rayan imbricated the dorsal joint capsule. 34 , 37 , 42 Additionally, Kronlage et al. employed an internal brace anchored to the trapezium and the first metacarpal base.…”

Thumb Carpometacarpal Stabilization With a Dorsal Capsule Repair Augmented With an Internal Brace

“…Postoperatively, patients were immobilized in a thumb spica splint which was removed alongside the K-wire at 4 week follow-up. In a subsequent cases series, Koehler and Rayan 16 evaluated outcomes of these patients treated with dorsoradial ligament capsulodesis and K-wire fixation. They reported a median VAS pain score at 6 months of 0.5 with 77% of patients reporting no pain.…”