Synthetic Tape Augmentation for Thumb Carpometacarpal Joint Instability: Surgical Technique

Abstract

Background Dorsal thumb carpometacarpal (CMC) instability can occur after traumatic injury and can lead to persistent pain and dysfunction of the hand. We present a case report of a joint-sparing technique for recurrent thumb CMC instability after failed Eaton-Littler procedure. Case Description We describe a technique to repair the dorsal radial ligament and augment the repair with dorsal synthetic tape. To illustrate this technique, we describe a patient who underwent the synthetic tape augmentation procedure for recurrent thumb CMC instability after a failed Eaton-Littler reconstruction. Preoperative and postoperative grip strength, appositional pinch, oppositional pinch, radial abduction, palmar abduction, and postoperative quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) were recorded. At final follow-up 18 months after surgery, the patient had returned to manual work without any functional sequelae. The thumb CMC joint was stable and his postoperative QuickDASH score was 15.9. Literature Review Thumb CMC instability has traditionally been treated with Eaton-Littler ligament reconstruction which uses a slip of flexor carpi radialis tendon to reconstruct the deficient ligaments. More recently, the importance of the dorsal radial ligament in joint stability has been recognized and new procedures have been described to reconstruct the dorsal radial ligament. To our knowledge, synthetic tape augmentation for thumb CMC instability has not yet been described for this pathology. Clinical Relevance Synthetic tape augmentation for dorsal thumb CMC instability may be considered in the management of dorsal thumb CMC joint instability.

Keywords: Eaton–Litter reconstruction; internal brace augmentation; suture; tape augmentation; thumb carpometacarpal instability.

Fig. 1

( A ) View of the left thumb carpometacarpal (CMC) joint at rest. ( B ) Dorsal stress view of the thumb CMC joint with instability. Anteroposterior ( C ) and lateral ( D ) X-rays of the patient's left thumb after the previous failed Eaton–Littler reconstruction.

Fig. 2

Sagittal oblique T2 magnetic resonance imaging of the thumb carpometacarpal joint demonstrating a T2 hyperintense fluid cleft along the ulnar aspect of the distal attachment of the anterior oblique, ligament suggestive of a high-grade partial tear. Additionally, there is advanced thickening, signal heterogeneity, and laxity involving the dorsal ligament complex.

Fig. 3

V configuration of synthetic tape in metacarpal and trapezium.

Fig. 4

Posteroanterior ( A ) and lateral ( B ) intraoperative fluoroscopy of the thumb confirming carpometacarpal joint reduction and suture anchor configuration.

Fig. 5

Postoperative lateral ( A ) and anteroposterior ( B ) X-rays demonstrate satisfactory alignment.