Comparison of Ligament Reconstruction Tendon Interposition and Trapeziometacarpal Interposition Arthroplasty for Basal Joint Arthritis

Many modifications to trapeziectomy have been proposed for the treatment of thumb basal joint arthritis. Their final outcomes have been discussed intensively, whereas functional changes in the early post-operative period have not been fully documented. The purpose of the present study is to evaluate an early functional change following our modified ligament reconstruction with tendon interposition (LRTI) arthroplasty. Nine patients (ten thumbs) were included in this study. Pain levels, strength, and mobility were assessed before and after surgery at intervals of two months. Pain level significantly improved at two months after surgery. Grip and pinch strengths had increased gradually after a temporal decrease at two-month follow-up, and were significantly stronger at six months after surgery. Palmar abduction improved significantly at six months after surgery, whereas opposition did not change significantly. A modified LRTI is an effective procedure in terms of early functional improvement of pain, strength, and mobility.

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Surgical management of basal Joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplast

The Journal Of Hand Surgery ◽

10.1016/s0363-5023(86)80137-x ◽

1986 ◽

Vol 11 (3) ◽

pp. 324-332 ◽

Cited By ~ 422

Author(s):

Richard I. Burton ◽

Vincent D. Pellegrini

Keyword(s):

Surgical Management ◽

Ligament Reconstruction ◽

Basal Joint ◽

Tendon Interposition ◽

Joint Arthritis

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Changes in Key Pinch Strength after Excision of the Trapezium and Total Joint Arthroplasty

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2003.09.004 ◽

2004 ◽

Vol 29 (1) ◽

pp. 40-41 ◽

Cited By ~ 20

Author(s):

L. DE SMET ◽

W. SIOEN ◽

D. SPAEPEN

Keyword(s):

Total Joint Arthroplasty ◽

Ligament Reconstruction ◽

Joint Arthroplasty ◽

Pinch Strength ◽

Pinch Force ◽

Basal Joint ◽

Tendon Interposition ◽

Joint Arthritis

Key pinch force was measured preoperatively and at follow-up (mean 25 months) in patients treated for basal joint arthritis by either trapziectomy with ligament reconstruction and tendon interposition ( n=26) or total joint arthroplasty ( n=27). There was a significant increase in key pinch strength with both treatments, but no difference between the two treatments. Total joint arthroplasty does not appear to produce stronger key pinch than trapziectomy with ligament reconstruction and tendon interposition.

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Long-term results of modified ligament reconstruction and tendon interposition for thumb basal joint arthritis

Journal of the Chinese Medical Association ◽

10.1097/jcma.0000000000000130 ◽

2019 ◽

Vol 82 (8) ◽

pp. 655-658

Author(s):

Yi-Chao Huang ◽

Hui-Kuang Huang ◽

Yu-An Liu ◽

Jung-Pan Wang ◽

Ming-Chau Chang

Keyword(s):

Ligament Reconstruction ◽

Long Term Results ◽

Basal Joint ◽

Tendon Interposition ◽

Joint Arthritis

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Basal Joint Arthrosis

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80093-3 ◽

1996 ◽

Vol 21 (2) ◽

pp. 177-181 ◽

Cited By ~ 51

Author(s):

R. K. KADIYALA ◽

R. H. GELBERMAN ◽

B. KWON

Keyword(s):

Ligament Reconstruction ◽

Proximal Phalanx ◽

Joint Arthroplasty ◽

Interposition Arthroplasty ◽

Basal Joint ◽

Before And After ◽

Ligamentous Reconstruction ◽

Degenerative Arthrosis ◽

Tendon Interposition ◽

Space Ratio

A radiographic method was developed, the trapezial space ratio, for assessing the space occupied by the trapezium (a space defined by the distal scaphoid and thumb metacarpal base divided by the thumb proximal phalanx). This method was applied to 100 normal thumb radiographs and to the radiographs of 15 patients with symptomatic degenerative arthrosis of the thumb basal joint before and after operative treatment with ligamentous reconstruction and tendon interposition arthroplasty. The trapezial space ratio averaged 0.476 ± 0.033 for radiographs of normal thumbs, 0.372 ± 0.084 for the pre-operative radiographs of thumbs with symptomatic basal joint arthrosis, and 0.270 ± 0.078 for the radiographs of thumbs following basal joint arthroplasty. A significant reduction in the trapezial space ratio was noted when values from arthritic thumbs were compared to those of normal thumbs (22%; P<0.0001). A further reduction in the trapezial space ratio was noted when post-operative values were compared to pre-operative ones (27%; P< 0.0002). Comparing post-operative trapezial space ratio values to values obtained in normal thumbs, a reduction of 43% was found in those thumbs treated operatively. These finding indicate that the trapezial space is reduced significantly in thumbs with severe degenerative arthrosis compared to normal thumbs and that ligament reconstruction tendon interposition arthroplasty is not entirely successful in either restoring or maintaining the length of the thumb ray.

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Functional outcome of ligament reconstruction tendon interposition for basal joint arthritis of thumb

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171890 ◽

2017 ◽

Vol 3 (3) ◽

pp. 492

Author(s):

Saranjeet Singh Jagdev ◽

Subodh Kumar Pathak ◽

Nisheet Dave ◽

Abhijeet Salunke

Keyword(s):

Ligament Reconstruction ◽

Advanced Disease ◽

Pinch Strength ◽

Dash Score ◽

Care Hospital ◽

Strength Gain ◽

Basal Joint ◽

Tendon Interposition ◽

Joint Arthritis ◽

Cmc Joint

Background: Thumb carpometacarpal osteoarthritis is a common disease, affecting up to 11% and 53% of men and women in their 50s respectively, which leads to pain, stiffness, weakness of the CMC joint. Patients with advanced disease have multiple surgical options including ligament reconstruction with tendon interposition, resection arthroplasty, silicone implantation, or total joint arthroplasty. The aim of study was to evaluate results of LRTI for CMC joint arthritis. Methods: This is a series of 29 patients operated in a tertiary care hospital. All patients included in the study were seen in the outpatient and identified to have basal joint arthritis according to their clinical presentation and classified on the basis of radiologic appearance. Trapeziectomy with ligament reconstruction with tendon interposition was done for patients with advanced disease. All the patients were followed up and assessed for function and disability using DASH score.Results: Average duration of follow up was 36 months with average tip pinch strength gain was 75%, key pinch strength gain 80% , grip strength gain 80 % of other limb. Significant Improvement in active 1st web space angle was seen with average of 19.5 degree. Average DASH score was 4.14. Nobody had extreme pain, 3 had mild pain and 2 had moderate pain. Conclusions: Based on our observation of DASH scores, the results have remained encouraging in most of the cases with restoration of normal anatomy to provide a stable and functional thumb. The success of LRTI in treating trapeziometacarpal arthritis has withstood the test of time.

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Thumb-Basal Joint Arthroplasty Outcomes and Metacarpal Subsidence: A Prospective Cohort Analysis of Trapeziectomy With Suture Button Suspensionplasty Versus Ligament Reconstruction With Tendon Interposition

Hand ◽

10.1177/1558944721994227 ◽

2021 ◽

pp. 155894472199422

Author(s):

Owolabi Shonuga ◽

Kristen Nicholson ◽

Jack Abboudi ◽

Gregory Gallant ◽

Christopher Jones ◽

...

Keyword(s):

Ligament Reconstruction ◽

Demographic Data ◽

Cohort Analysis ◽

Joint Arthroplasty ◽

Pinch Strength ◽

Complication Rates ◽

Suture Button ◽

Basal Joint ◽

Tendon Interposition ◽

Cmc Joint

Background Thumb carpometacarpal (CMC) joint arthroplasty is a common procedure in the surgical management of symptomatic thumb basal joint arthritis. Following trapeziectomy, a number of suspensionplasty techniques are often used, but limited comparative evidence exists between these techniques. The central aim of this study was to prospectively compare the outcomes of 2 suspensionplasty techniques following trapeziectomy: suture button (TightRope) versus ligament reconstruction and tendon interposition (LRTI). Methods Prospective data were collected on 112 consecutive patients with Eaton stage III-IV thumb CMC arthritis who underwent open trapeziectomy and suspensionplasty. There were 53 LRTI and 59 TightRope suspensionplasty procedures. Outcomes were measured using the Quick Disabilities of the Arm, Shoulder, and Hand ( QuickDASH) questionnaire, Visual Analogue Scale (VAS) for pain, radiographic analysis, and lateral pinch strength. Patient demographic data and complications were also recorded. Results Patients undergoing TightRope suspensionplasty had significantly higher trapeziometacarpal index and thus less subsidence than the LRTI group at 2 weeks (0.22 vs 0.17 [ P < .0001]) and 3 months (0.17 vs 0.15 [ P < .05]) postoperatively. TightRope suspensionplasty also had a significantly lower QuickDASH score at 2 weeks (64.7 vs 74.6 [ P < .05]), 3 months (20.7 vs 32.5 [ P < .05]), and 1 year postoperatively (7.57 vs 21.5 [ P < .05]) compared with the LRTI group. However, there was no difference in VAS pain, lateral pinch strength, reoperation, or complications at any time point between groups. Conclusions Thumb CMC joint arthroplasty performed with a TightRope suspensionplasty versus LRTI yielded short-term improved resistance to subsidence, long-term greater improvement in clinical outcome by QuickDASH, and no difference in pain or complication rates.

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