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. 2023 Apr 25;24(1):328.
doi: 10.1186/s12891-023-06420-y.

Surgical treatment of carpometacarpal thumb arthritis with trapeziectomy and intra-tendon (FCR) suspension with one-loop APL: comparative cohort study

Marco Passiatore  1 , Giuseppe Taccardo  2 , Vitale Cilli  3 , Giuseppe Rovere #  4 , Francesco Liuzza  2 , Lucia Pannuto  5 , Rocco De Vitis #  6
Affiliations

Surgical treatment of carpometacarpal thumb arthritis with trapeziectomy and intra-tendon (FCR) suspension with one-loop APL: comparative cohort study

Marco Passiatore et al. BMC Musculoskelet Disord. .

Abstract

Background: One of the current choices of treatment for Trapeziometacarpal (TMC) joint arthritis is trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. The Ceruso's technique consists of complete trapezial excision and abductor pollicis longus (APL) tendon suspension. The APL tendon is tied to the flexor carpi radialis (FCR) tendon with two loops, one around it and one inside, and then used as interposition tissue. The purpose of the present study was to compare two different techniques of a trapeziectomy with ligament reconstruction and tendon interposition arthroplasty using the Abductor Pollicis Longus (APL) tendon, which is only Once Looped Around (OLA) versus Once Looped Inside (OLI) the Flexor Carpi Radialis (FCR) tendon.

Methods: A single-center, retrospective study (Level of evidence: III) has been conducted on sixty-seven patients older than 55 years (33 OLI, 35 OLA), assessing clinical outcomes for at least 2 years of post-surgery follow-up. The outcomes were to assess and compare surgical outcomes comparing the two groups, in terms of subjective and objective evaluation for both groups at the last follow-up (primary outcome), and at the intermediate follow-ups (three and six months). Complications were also assessed.

Results: The authors found an improvement in pain, range of motion, and function, with equivalent results for both techniques. No subsidence was observed. FCR tendinitis was significantly reduced with OLI, as well as the need of post-operative physiotherapy.

Conclusions: The one-loop technique allows for reduced surgical exposure, providing excellent suspension and clinical outcomes. Intra FCR loop should be preferred to improve post-surgical recovery.

Level of evidence: Level III study. This is a retrospective cohort study (written according to STROBE guidelines).

Keywords: Carpometacarpal thumb arthritis; Loop; Tendons; Trapeziectomy.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
A Ceruso’s technique. B Catalano’s modification, called the OLA (once-looped around) technique. C Once-looped intratendineous” (OLI) technique. M1: first metacarpal bone. M2: second metacarpal bone. S: scaphoid. FCR: flexor carpi radialis. APLp: palmar slip of abductor pollicis longus. APLd: dorsal slip of abductor pollicis longus. The APLd is sutured on the capsule after the interposition, and the capsule is closed
Fig. 2
Fig. 2
OLI technique. The radial artery (R) has been exposed. A “V-shaped" capsular flap (C) has been dissected and flipped distally under the retractor. The dorsal subunit of APL has been harvested and passed through the FCR. The symbol * indicated the split into the FCR. T: trapezoid. S: scaphoid (distal pole)
Fig. 3
Fig. 3
Progression of clinical improvement in terms of pain, MHQ and DASH scores pre-surgery (T0), after 3 months (T1), after 6 months (T2) and at the last follow-up (two years, T3)
See this image and copyright information in PMC

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References

    1. Haara MM, Heliövaara M, Kröger H, et al. Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality. J Bone Joint Surg Am. 2004;86(7):1452–1457. doi: 10.2106/00004623-200407000-00013. - DOI - PubMed
    1. Taccardo G, DE Vitis R, Parrone G, Milano G, Fanfani F. Surgical treatment of trapeziometacarpal joint osteoarthritis. Joints. 2013;1(3):138–144. doi: 10.11138/jts/2013.1.3.138. - DOI - PMC - PubMed
    1. Dell PC, Brushart TM, Smith RJ. Treatment of trapeziometacarpal arthritis: results of resection arthroplasty. J Hand Surg Am. 1978;3:243–249. doi: 10.1016/S0363-5023(78)80088-4. - DOI - PubMed
    1. Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55:1655–1666. doi: 10.2106/00004623-197355080-00010. - DOI - PubMed
    1. Gervis WH. Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. Postgrad Med J. 1948;24(271):262–264. doi: 10.1136/pgmj.24.271.262. - DOI - PMC - PubMed