Abstract
Various authors have linked hypermobility at the trapeziometacarpal joint to future development of arthritis. When examining hypermobility, the anterior oblique ligament (AOL) and ulnar collateral ligament (UCL) are the two most important supporting structures. Literature suggests that reconstructive techniques to correct the hypermobility can prevent subsequent development of osteoarthritis. Eaton and Littler proposed a surgical technique to reconstruct the ligamentous support of this joint in 1973. This cadaveric biomechanical study aimed to evaluate the resultant effect on the mobility of the thumb metacarpal following this reconstructive technique. Seventeen cadaveric hands were prepared and strategically placed on a jig. Movements at the trapeziometacarpal joint were created artificially. Static digital photographs were taken with intact AOL and UCL at trapeziometacarpal joint (controls), for later comparison with those after sectioning of these ligaments and following Eaton-Littler reconstructive technique. The photographic records were analyzed using Scion.Image. Statistical analysis was performed using Minitab. A paired T-test was used to establish statistical relevance. Results confirmed that the AOL and UCL had a major role in limiting excessive motion at the trapeziometacarpal joint, principally in extension. Division of these ligaments produced a significant degree of subluxation of the metacarpal at this joint with thumb in neutral position (p-value = 0.013). Reconstruction of the ligamentous support using the Eaton-Littler technique reduced the degree of extension available (p-value = 0.005). This study confirmed the important role of the AOL and UCL in maintaining trapeziometacarpal joint stability, and that the Eaton-Littler reconstructive technique reduces the degree of hyperextension at this joint.
