LIGAMENT RECONSTRUCTION AND TENDON INTERPOSITION ARTHROPLASTY USING FLEXOR CARPI RADIALIS FOR FIRST CARPO-METACARPAL JOINT ARTHRITIS: RESULTS OF A SINGLE SURGEON SERIES OF 65 PATIENTS WITH A MINIMUM 3 YEAR FOLLOW UP.

Abstract

Introduction: Osteoarthritis of thumb CMC joint is a common pathology. Several non-prosthetic surgical options exist. There is abundant literature both in favour of and against combining trapeziectomy with ligament reconstruction and/or tendon interposition (LRTI). This study provides qualitative and quantitative outcomes assessment of a single surgeon series of consecutively operated 65 patients with trapezio-metacarpal joint arthritis using Trapeziectomy with LRTI.

Methods: 50 female and 15 male patients at an average age of 63 at the time of surgery were followed up for a mean of 3 years, 4 months. Radial half of flexor carpi radialis is dissected using a Carroll tendon retriever and passed through a transosseous hole in the thumb metacarpal base to exit on its dorsum. Patients were put in a full below elbow cast for a period of 4 weeks following which hand therapy was instituted. Patients were evaluated using quick DASH score and objective data like thumb opposition, radiographic scaphometacarpal mobility and gap, pinch and grasp strength. All operations were carried out by senior author.

Results: Good to excellent results were obtained in 59 cases with satisfactory opposition. Pinch strength was 4.3 Kg being 1 to 2 Kg less than reference range. Scoring with quick DASH did not decrease with the longevity of follow up. No complications were encountered. No correlation was found between variables like age, sex, dominance, occupation, primary diagnosis, reduced space on follow up radiographs, severity of arthritic changes and final outcome.

Discussion: Present study is one of the largest consecutive single surgeon series reported recently. All efforts were made to eliminate confounding factors like multi surgeons, modifications of technique, different patient populations etc. The study supports the concept of interposition arthroplasty in the treatment of basal joint arthritis of thumb provided strict attention to the details of surgical technique is observed.