The Eaton-Littler Ligament Reconstruction in Thumb Carpometacarpal Joint Instability: Outcomes and Prognostic Factors in 74 Patients

Abstract

Background: The Eaton-Littler ligament reconstruction is widely used for thumb carpometacarpal instability, yet the existing literature lacks a thorough analysis of the outcomes for nontraumatic instability. This study aimed to assess the outcomes of the Eaton-Littler ligament reconstruction and to identify prognostic factors associated with postoperative pain.

Methods: Patients with nontraumatic carpometacarpal joint instability, unresponsive to conservative treatment, were included in this prospective study. The visual analog scale (range 0 to 100) for pain and the Michigan Hand Outcome Questionnaire (MHQ; range 0 to 100) total score were measured at intake and 3 and 12 months postoperatively. Multivariable linear regression was used to analyze the association between preoperative variables and the 12-month MHQ pain score.

Results: Seventy-four patients undergoing Eaton-Littler ligament reconstruction were included. The median visual analog scale pain score improved significantly ( P < 0.001) from intake (70 [interquartile range, 63 to 78]) to 12 months postoperatively (27 [interquartile range, 7 to 56]). The mean MHQ total score also improved significantly ( P < 0.001) from intake (52; SD, 13) to 12 months (74; SD, 17). All thumbs were stable at follow-up with preserved range of motion. Grip and pinch strength also improved significantly after surgery. Undergoing a concurrent surgery during ligament reconstruction and a better MHQ pain score at intake were found to be predictors of a favorable postoperative MHQ pain score.

Conclusions: Patient- and clinician-reported outcomes improved significantly at 3 and 12 months after Eaton-Littler ligament reconstruction. The authors advise concurrent hand pathologies resulting from instability (eg, tendinitis, synovitis) to be treated simultaneously during ligament reconstruction.

Clinical question/level of evidence: Therapeutic, III.

Fig. 1.

Modified Eaton–Littler ligament reconstruction. (Left) A strip of the flexor carpi radialis (FCR) tendon is harvested, and a bone tunnel is created through the base of the first metacarpal. (Right) The FCR strip is passed through the bone tunnel and sutured upon the abductor pollicis longus (APL) tendon and tied to the FCR tendon. (Copyright © 2024 J. Michiel Zuidam, MD, PhD, Esser Masterclass. Published with permission from Dr. Zuidam.)

Fig. 2.

Study flowchart.

Fig. 3.

Median VAS pain score before Eaton–Littler ligament reconstruction and 3 and 12 months postoperatively. The gray boxes depict the interquartile range. The VAS pain score is plotted for each patient. The green lines depict the patients who had improved VAS pain score from intake to 12 months postoperatively. The red lines depict the patients who did not have improvement. The dots represent outliers. The median VAS pain score improved significantly after Eaton–Littler ligament reconstruction. Large between-subject variability was observed at all time points.

Fig. 4.

Mean MHQ total score before Eaton–Littler ligament reconstruction and 3 and 12 months postoperatively. The error bars indicate 95% confidence intervals. The MHQ total score is plotted for each patient. The green lines depict the patients who improved in MHQ total score from intake to 12 months postoperatively. The red lines depict the patients who did not have improvement. The mean MHQ total score improved significantly after Eaton–Littler ligament reconstruction. Large between-subject variability was observed at all time points.

Fig. 5.

Mean MHQ total, pain, and function scores before Eaton–Littler ligament reconstruction and 3 and 12 months postoperatively. The error bars indicate 95% confidence intervals. Mean MHQ total, pain, and function scores exhibit significant (P < 0.001) improvement after Eaton–Littler ligament reconstruction.