Arthroscopic Partial Trapeziectomy and Free Tendon Suspension and Interposition Combined with Internal Brace for Basal Joint Arthritis of Thumb

Abstract

Background: Carpometacarpal thumb arthritis causes pain and functional limitations. Methods: This study evaluated the efficacy of arthroscopic partial trapeziectomy with free palmar longus tendon suspension and interpositional arthroplasty, combined with a soft anchor internal brace, for the treatment of thumb basal joint arthritis. Between August 2010 and April 2020, 60 thumbs with symptomatic basal joint arthritis (Eaton stage II-III) were treated using this minimally invasive technique. Results: The cohort included 52 female and 8 male patients (mean age, 62.6 ± 4.3 years), who underwent clinical follow-up for 28.7 ± 3.0 months. VAS pain scores decreased from 5.7 ± 0.5 to 1.0 ± 0.7 and 7.1 ± 0.6 to 1.4 ± 0.9 (p < 0.001) during rest and activity, respectively. Thumb range of motion increased from 43.3 ± 11.3 to 54.2 ± 9.8 degrees, while pinch strength improved from 47.3 ± 9.5% to 88.8 ± 17.3% of the contralateral side (p < 0.001). Patients with Eaton stage II disease demonstrated better outcomes than those with stage III disease. Radiographically, minimal proximal migration of the first metacarpal (mean, 1.2 mm) was observed, with no cases of scaphotrapezial joint arthritis. Conclusions: Arthroscopic partial trapeziectomy with tendon suspension/interposition and an internal brace is an effective treatment for Eaton stage II-III basal joint arthritis, offering significant pain relief, functional improvement, and joint stability, while preserving the scaphotrapezial joint.

Keywords: arthroscopic partial trapeziectomy; carpometacarpal thumb arthritis; joint arthritis.

Figure 1

Preoperative radiograph of a 68-year-old female with Eaton stage III basal joint arthritis. The black arrow indicates the collapsed first carpometacarpal joint with osteophyte formation and subchondral sclerosis.

Figure 2

Radial portal (RP) created over the radial border of APL, followed by the creation of the thenar portal (TP) over the FCR tendon region.

Figure 3

Arthroscopic evaluation and initial surgical steps for basal joint arthritis. (a) Arthroscopic view demonstrating stage III arthritis of basal joints. (b) Arthroscopic view showing one-third of the trapezium resected with power burr. (c) Thermal shrinkage of volar ligaments (beak) and capsule with RF probe. (d,e) Soft anchor (1.3 mm) applied to the base of the 2nd metacarpal region.

Figure 4

Tendon graft harvesting procedure. (a) PL tendon graft harvested from the volar forearm. (b) Free tendon graft taken from the same forearm site. (PL, palmaris longus.)

Figure 5

Tendon suspension and internal brace construction technique. (a) The PL tendon graft was passed across the joint from the thenar portal to the radial portal. One arm of the anchor was also pulled back to the radial portal. (b,c) The tendon graft was woven with the APL and passed back through the joint to the thenar portal. The anchor arm was also woven with the APL and returned to the thenar portal. (d) The PL tendon graft was woven with the FCR tendon and sutured in place. The soft anchor arm was also woven into the FCR tendon. (e) The residual tendon graft was fashioned into a tendon ball. (f) The remaining arm of the anchor was passed through the tendon ball, which was then pushed into the joint. (g) Arthroscopic view showing the tendon ball positioned in the basal joint and secured with the soft anchor. (PL, palmaris longus; APL, abductor pollicis longus; FCR, flexor carpi radialis).

Figure 6

Basal joint fixed using a 1.2 mm K-wire for 4 weeks. Postoperative radiograph at 24-month follow-up showing maintenance of the arthroplasty space. The white arrow indicates the well-reserved space between the base of the first metacarpal and the remaining trapezium.

Figure 7

Postoperative radiograph at 2-year follow-up showing minimal proximal migration (1.2 mm) of the first metacarpal base. The black arrow indicates the preserved arthroplasty space between the base of the first metacarpal and the remaining trapezium.