Introduction and Aims: While successful long-term results have been shown for ligament reconstruction–tendon interposition arthroplasty for treatment of thumb basal joint osteoarthritis, the need for invasive ligament reconstruction has not been established. In this study we describe long-term results utilising the technique of tendon interposition arthroplasty with dynamic tendon transfer and capsulorrhaphy.
Method: Twenty-four thumbs (21 patients) were evaluated at an average of 7.1 years (1.8–19.5 years) post-procedure. Capsulorrhaphy was performed utilising APL tendon slips where tissue was insufficient. The APB origin was advanced via tendon transfer (FCR to APB), providing a stabilising abductor moment. Subjective assessment was performed using Visual Analogue Scores (VAS), Disabilities of Arm, Shoulder, Hand (DASH) scores, and patient satisfaction scales. Objective assessment included post-operative range of motion (ROM), grip/pinch strength, and radiographs for interposition arthroplasty height.
Results: Twenty of 21 patients (95%) were satisfied and described results as either good or excellent. Twenty of 21 patients (95%) would undergo surgery again. Mean VAS was 8.7 at rest and 10.2 with activity (0, no pain; 100, maximum pain). Mean DASH score was 16.9 (range from 0, no difficulty performing daily tasks to 100, unable to perform daily tasks). ROM, grip, lateral and tip pinch strengths were comparable with those of the contralateral thumb. AP radiographs showed preservation in 12 of 12 patients (100%). Fourteen of 21 patients received the procedure on their dominant hand.
Conclusion: Treatment of basal joint osteoarthritis with our technique provided stable and functional reconstructions, resulting in excellent pain relief. Results were comparable to, or better than, those previously cited in the literature for alternative procedures. These results suggest that dogma requiring static ligament reconstruction or suspension may need to be re-evaluated.
