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. 2021 Jul 5;10(6):551-557.
doi: 10.1055/s-0041-1731385. eCollection 2021 Dec.

Arthroscopically Assisted Eaton-Littler Trapeziometacarpal Ligamentoplasty

Fabian G P Moungondo  1   2 , Antonia Gkotsi  1   2 , Emmanuel Camus  2   3 , Luc Van Overstraeten  1   2   4 , Frédéric A Schuind  1   2
Affiliations

Arthroscopically Assisted Eaton-Littler Trapeziometacarpal Ligamentoplasty

Fabian G P Moungondo et al. J Wrist Surg. .

Abstract

Background Eaton-Littler ligamentoplasty has proven its efficacy in the treatment of trapeziometacarpal (TMC) instability. Description of Technique In this article, we describe the arthroscopically assisted Eaton-Littler ligamentoplasty through two clinical cases. Patients and Methods Arthroscopy is used to accurately place the metacarpal bone tunnel and pass the slip of flexor carpi radialis tendon in the latter. This procedure avoids soft-tissue dissection and could improve the outcome of this well-known surgery. Results The two clinical cases showed good short-term outcome with a decrease of pain and good function. Conclusions Arthroscopy to assist Eaton-Littler TMC ligamentoplasty is technically feasible, allowing a less invasive surgery. A larger prospective controlled study with a longer term outcome is mandatory to assess the real advantages of this modified procedure.

Keywords: Eaton–Littler ligamentoplasty; arthroscopy; instability; osteo-arthrosis; trapeziometacarpal joint.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
(Color online) Arthroscopic portals (stars) and incisions (arrows) needed during the procedure to harvest the flexor carpi radialis (FCR) strip and proceed to the ligamentoplasy (1R portal: red star; 1U portal: blue star).
Fig. 2
Fig. 2
Harvesting of the flexor carpi radialis (FCR) tendon strip and Krackow sutures at its proximal stump (α: traction suture α).
Fig. 3
Fig. 3
Drilling of the metacarpal bone tunnel by using an arthroscopic drill guide, aiming the metacarpal beak under arthroscopic control.
Fig. 4
Fig. 4
The suture β is passed into the bone tunnel and withdrawn through the 1R portal. The traction suture α is passed through the flexor carpi radialis (FCR) tendon sheath and withdrawn through the 1R portal with the FCR tendon strip ( A ). Passing of the FCR tendon strip into the bone tunnel by using a shuttle relay suture β ( B–D ). Stretching of the tendon is mandatory to release the remaining adhesion up to its metacarpal insertion.
Fig. 5
Fig. 5
Suture of the flexor carpi radialis tendon strip to itself near to the bone tunnel level after passing under the flexor pollicis brevis, abductor pollicis longus, and around itself at the wrist crease.
Fig. 6
Fig. 6
Case 1, postoperative radiography of the fifth finger showing the missed trapeziometacarpal (TMC) subluxation ( A ). CT scan showing an avulsion fracture of the metacarpal beak ( B, C, D ).
Fig. 7
Fig. 7
Case 1, arthroscopic view of the anterior oblique ligament (AOL) ( A ). Focal stage IV chondral lesion (arrow) on the trapezium ( B ). Flexor carpi radialis (FCR) tendon strip at the ulnar side of the AOL (C).
Fig. 8
Fig. 8
Case 1, radiography 21 months postoperatively. The trapeziometacarpal joint is still reduced and there is no sign of osteoarthritis. Note the bone tunnel at the metacarpal basis (arrows).
Fig. 9
Fig. 9
Case 2, preoperative radiography showing no sign of osteoarthritis.
Fig. 10
Fig. 10
Case 2, arthroscopic view showing a stage IV chondropathy, observed on the radial side of the trapezium (arrow) ( A ). Flexor carpi radialis (FCR) strip passing on the ulnar side of the anterior oblique ligament (AOL) ( B ).
Fig. 11
Fig. 11
Case 2, 11 months after surgery. The trapeziometacarpal joint is still reduced and there is no sign of osteoarthritis. Note the bone tunnel at the metacarpal basis (arrows).
See this image and copyright information in PMC

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