Ligament reconstruction and tendon interposition for thumb basal arthritis

Abstract

Arthritis at the base of the thumb is common and debilitating. Arthroplasty has evolved over 3 decades to become a highly refined surgical procedure, with excellent results. This article summarizes the history, method, and expected results of basal joint arthroplasty, and the authors describe their method of ligament reconstruction and tendon interposition for thumb basal arthritis.

Fig. 1

(A) Putative plan for incision for main surgical procedure. (B) Plan for flexor carpi radialis (FCR) harvest. (C) Note the branch of the radial sensory nerve.

Fig. 2

(A) Native position of radial artery. (B) Mobilized and proximally displaced artery revealing the capsule of the carpometacarpal joint.

Fig. 3

Retention sutures hold the capsule open and allow for later tight closure over the interposition bolus.

Fig. 4

(A) Schematic of channel in the metacarpal base. (B) Gouge in the channel as it is being formed. (C) Completed channel.

Fig. 5

(A) Harvest of the FCR. (B) Passing of FCR into the arthroplasty space.

Fig. 6

(A) The deep capsule is closed and (B) sutures are kept long, emanating from the deep closure to allow for insertion of the interpositional bolus. (C) The FCR is passed through the channel.

Fig. 7

(A) Schematic depicting the plan of placement of K-wires with the thumb in the functional position. (B) K-wire placement. (C) Suture of the snugly tensioned tendon to periosteal tissue.

Fig. 8

(A) The metacarpal base is resurfaced by suturing the FCR to itself at the base of the arthroplasty space. (B) The interpositional bolus is formed by folding the tendon over a Keith needle. (C) The tendon is fully folded in the form of an accordion. (D) The quadrants of the tendon interposition are sutured and the needles threaded, with the deep sutures passed across the bolus.

Fig. 9

(A) Schematic depicting inserted interpositional bolus with sutures in deep capsule. (B) Bolus inserted into arthroplasty space. (C) Tight capsular closure over bolus.

Fig. 10

Transfer of the extensor pollicis brevis (EPB). (A) Schematic of plan of transfer. (B) Suture of EPB to FCR exiting the channel. (C) Tucking and closing of the channel over the transfer of EPB.