Arthroscopy-assisted partial trapeziectomy combined with ligament reconstruction for thumb carpometacarpal joint osteoarthritis: A different technique

Abstract

Background: There is no consensus on the best surgery option for thumb carpometacarpal osteoarthritis (CMC OA). The traditional method has the risk of large trauma, obvious metacarpal subsidence, and decreased stability. The aim of this study is to introduce a different technique to restore the function and stability of the first carpal metacarpal joint with minimal trauma, rapid pain relief, reduced complications, and the clinical outcomes in the long-term follow-up was evaluated and statistically analyzed.

Methods: This was a retrospective study of 10 patients with a mean age of 51.8 years. The surgery consisted of removing partial trapezium through arthroscopy, reconstructing the stability with flexor carpi radialis suspension and tendon interposition. The subjective assessment included visual analog scale (VAS) of pain, quick disabilities of the arm, shoulder, and hand (Quick-DASH) score, and patient satisfaction. The range of motion, grip strength, pinch strength, and radiographic assessment, which can reflect stability of the thumb, were objectively evaluated and statistically analyzed.

Results: Ten patients were monitored at a mean follow-up of 6.8 years. The mean grip strength improved significantly from 16.64 to 22.57 kg after surgery. Pinch strength improved significantly from 3.72 to 5.71 kg on average. The Kapandji score improved significantly from 5.7 to 8.6 on average. 80% (8/10) of the patients were satisfied with this surgery. On objective indicators, the VAS score decreased significantly from 6.4 to 1.3 on average. The mean Quick-DASH score improved significantly from 6.1 to 28.9. Postoperative x-ray showed slight subsidence and dislocation of the first metacarpal in two patients and did not affect the function by measurement.

Conclusion: Arthroscopy-assisted partial trapezium resection combined with ligament reconstruction could be a workable and promising surgical technique in patients with thumb CMC OA. It can offer the advantages of minimizing surgical injury by preserving the first carpal metacarpal joint capsule to protect its stability, with a rapid pain relief, function improvement, and satisfactory results in patients' clinical measurements.

Keywords: arthroscopy; carpometacarpal joint (CMC); ligament reconstruction and tendon interposition; osteoarthritis; thumb; trapeziectomy.

Figure 1

Radiograph of CMC OA with loss of joint space and radial dislocation. (Left) (a): axis of the trapezium and (b): axis of the first metacarpal; (right) (a): uncovered length of trapezium and (b): total length of trapezium.

Figure 2

Arthroscopy-assisted partial trapezium resection. (Left): Partial trapeziectomy is performed with the 1.9 mm burr. (Right): The articular surface of the part of the trapezium is removed until it shows hemispherical fossa.

Figure 3

The radial half of the tendon is transected and dissociated distally to the level of the CMC joints.

Figure 4

Ligament reconstruction. Surrounding the base of first metacarpal, one half of the tendon passes from the volar side to the dorsal side through the transosseous tunnel in first metacarpal and sutures with itself on the volar side.

Figure 5

Fluoroscopy shows a good position with slight subsidence of the first metacarpal bone. (Above): Two months after surgery. (Below): Six months after surgery.

Figure 6

(Left) VAS values for pain. (Right) Quick-DASH score outcomes. **p = 0.001 and ****p < 0.0001.