Clinical and Patient-Reported Outcomes After Ligament Reconstruction for Traumatic Thumb Carpometacarpal Instability

Abstract

Purpose: The effectiveness of ligament reconstruction for chronic traumatic thumb carpometacarpal (CMC) instability is debated because of concerns of trauma-induced cartilage damage affecting postoperative results. This study aimed to assess patient- and clinician-reported outcomes of ligament reconstruction in these patients.

Methods: This study included patients with chronic traumatic CMC instability undergoing various ligament reconstruction techniques. The visual analog scale (range 0-100) for pain and the Michigan Hand Outcome Questionnaire (MHQ, range 0-100) scores at intake were compared to those at 3 and 12 months and at long-term follow-up. Secondary outcomes included grip and pinch strength, range of motion, complications, and patient satisfaction. A linear mixed model was used to analyze which variables influence postoperative MHQ pain scores.

Results: Forty-three patients were included with a mean follow-up of 8 years (range, 3.2-12.5). The visual analog scale pain score significantly improved from 60 (95% CI, 53-67) at intake to 26 (95% CI, 18-33) at 12 months, remaining consistent over long-term follow-up. The MHQ total, pain, and function scores also improved considerably. All thumbs were stable after surgery with preserved range of motion. Grip and pinch strength notably improved. One patient progressed to osteoarthritis during follow-up. The dorsal ligament reconstruction technique was a predictor of worse postoperative MHQ pain scores.

Conclusions: Patient- and clinician-reported outcomes considerably improved postsurgery, affirming ligament reconstruction as a viable treatment for chronic traumatic CMC instability. The dorsal ligament reconstruction technique should be approached with caution.

Type of study/level of evidence: Therapeutic IV.

Keywords: Carpometacarpal instability; hand injuries; joint instability; ligament reconstruction; treatment outcome.