Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability

Abstract

Introduction Instabilities of the thumb carpometacarpal (CMC) joint, caused by idiopathic ligamentous hyperlaxity, trauma or other conditions may lead to pain, functional impairment and eventually osteoarthritis. Several techniques have been described to enhance stability of the CMC 1. The aim of this study was to evaluate postoperative outcomes after CMC 1 joint stabilization using a soft-tissue procedure in patients with chronic instability. Materials and methods This study was designed as a retrospective study with a single follow-up visit after a minimum of 1 year postoperatively. All patients who underwent stabilization of the CMC 1 with an abductor pollicis longus (APL) tendon strip for chronic, habitual instability were reassessed using clinical examination, dedicated outcome scores [Visual Analogue Scale (VAS); The Disability of the Arm, Shoulder and Hand (DASH) score; Nelson score; Kapandji opposition score], grip and pinch strength measurements, and radiographic examination. Results 12 patients (15 operated thumbs) with a mean age at surgery of 23.2 (± 9.3) years were included after a mean followup period of 3.5 (± 1.3) years. The postoperative outcomes indicated excellent results, with a mean DASH score of 13.3 (± 11.3), VAS 1.1 at rest (and 2.8 during stress) and Nelson score of 87.7 (± 11.3). Postoperative grip, pinch strength and passive stability were not significantly different between operated and non-operated sides (p = 0.852; p = 0.923 and p = 0.428, respectively). We observed one case of recurrent instability besides no other complications. However, patients with trapezium hypoplasia (5 of 12) were more prone to signs of radiographic instability during stress testing. Conclusions Thumb carpometacarpal stabilization with an APL tendon strip yielded excellent clinical outcomes and low morbidity in the mid-term. However, long-term follow-up is needed to assess specifically whether patients with trapezium hypoplasia may be more prone to clinical symptom recurrence than those with normal anatomy. Level of evidence Level IV

Recurrent Bilateral Basilar Joint Subluxation in a Teenage Boy

“…If LR had failed, CMC arthrodesis would have been an appropriate salvage procedure. It has been shown to provide a high level of patient satisfaction and symptomatic relief in patients with chronic, painful laxity, and it might have been considered 9 Ultimately, this case, in conjunction with the literature review, emphasizes early treatment and postreduction stability assessment, with LR, in the setting of long-term instability.…”

Acute Traumatic Isolated Subluxation of Trapeziometacarpal Joint: Case Report-Literature Review

“…Edmunds (2006) postulate that acute isolated dislocations of TMCJ requires open ligamentous reconstruction either by direct suturing or by tenodesis of the TMCJ using graft as flexor carpi radialis tendon [22] . Published treatment modalities, regarding tendon graft for reconstruction of TMCJ dislocation, included flexor carpi radialis tendon (FCR), Abductor pollicis longus (APL), Palmaris longus (PL) and most recently Extensor carpi radialis longus (ECRL) [6,17,31,32] . Eaton et al first introduced FCR tendon graft as an advantage of near location of the tendon to dislocated site and the ability to correct the hypermobility of the TMCJ (reconstruct the palmar ligament and reinforced dorsal capsule).…”

“…Baker et al (2014) first implement CMC joint suspension arthroplasty and report improved pinch and grip strength and painless function of the thump [32] . Stauffer et al (2020) used as tendon graft APL and reported in 15 operated thumbs that postoperative grip, pinch strength, and passive stability were not significantly different between operated and non-operated sides while Mean DASH score was 13.3 and VAS 1,1 [31] . Kim et al (2021) in a systematic review 85% report that most common tendon graft which utilize was FCR (57%) following by APL (29%) and all studies with this two methods prove normal range of motion without posttraumatic instability sustainment the effectiveness of the two methods [16] .…”

Thumb Carpometacarpal Suspension Arthroplasty With Flexor Carpi Radialis Ligament Reconstruction and Tendon Interposition Using An Absorbable Interference Screw: A Volar Approach Technique

“…Our results are similar to several studies of CMC arthroplasty utilizing the modified FCR LTRI technique in the literature reporting good mid-term to short-term outcomes. [15][16][17] Tomaino et al 18 reported on long-term outcomes including radiographic assessment of LRTI in 24 thumbs at long-term follow-up. Relief of pain was seen in 95% of patients.…”