Ligament Reconstruction and Tendon Interposition Using Flexor Carpi Radialis Tendon for the Treatment of Basilar Thumb Arthritis: A Case Report

Introduction: Basilar thumb arthritis is most common arthritis affected about 10% of middle aged women and one third of postmenopausal women had this condition. The disease is often not shown significant symptom, when become a symptomatic can provide 50% loss of function. Conservative treatment with mild arthtritis usually had a good respond. Surgery is indicated in patients who failed to conservative treatment. Ligament reconstruction and tendon interposition is the surgical approach commonly used to treat basal joint arthtritis. Case Presentation: A 61-year-old woman complained swelling and also pain at the base of the left thumb more than 1 year and unable to do a daily activity and getting worse, also complained weakness grip. Plain radiograph of hand showed the trapezial space height about 10mm and diagnosed with basilar thumb arthritis of the left hand Eaton stage III with DASH score pre operatively is 60.8. The patient done with LRTI procedure and used thumb spica cast for immobilized 4 weeks. The DASH Score Post operatively is 40.7 and after 6 months the score is improve to 19.2. Conclusion: Basal Thumb Arthritis is a common condition affecting postmenopausal women with a deformity consisting of a MCP hyperextension deformity accompanied by swelling, tenderness and crepitus. Eaton Classification used to staging of basal thumb arthritis and help to decide the treatment. LRTI is one approach to treat patients with CMC arthritis who has a high level of satisfaction and objectivity in measuring function, including restoring of the strength and ability of the affected thumb. Keywords: Basilar, Thumb, Joint, Arthritis, Ligament reconstruction, tendon interposition.

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Outcome of trapeziectomy with ligament reconstruction tendon interposition for the treatment of advanced thumb carpometacarpal arthritis: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210616 ◽

2021 ◽

Vol 7 (2) ◽

pp. 252

Author(s):

Eknoor Kaur ◽

Narender Saini ◽

Shashank Sharma ◽

Devi Sahai Meena

Keyword(s):

Ligament Reconstruction ◽

Dash Score ◽

Before And After ◽

The Mean ◽

Thumb Carpometacarpal ◽

A Prospective Study ◽

Tendon Interposition ◽

Grip Power ◽

Joint Arthritis ◽

Score Range

Background: The purpose of this study is to assess the functional outcome of the cases with advanced thumb carpometacarpal (CMC) arthritis treated with trapeziectomy and ligament reconstruction tendon interposition (LRTI) in terms of visual analogue scale (VAS), disabilities of the arm, shoulder and hand (DASH) score, Kapandji score, range of motion (ROM) of radial and volar abduction of the thumb, grip power, key pinch and the height of the trapezial space.Methods: In a prospective before and after interventional study of 30 patients with the advanced thumb CMC joint arthritis underwent the procedure. An average follows up period was 17.9 months.Results: The mean VAS decreased from 8.17 to 2.70. The mean Kapandji score and DASH score improved from 3.47 and 71.62 preoperative to 8.23 and 14.46 postoperative. Mean ROM for radial and volar abduction increased from 42.57° and 48° to 61°and 64.73° respectively. Mean key pinch power and grip power increased from 2.80 kg and 3.47 kg to 4.70 kg and 9.01 kg respectively. There was a significant decrease in height of the trapezial space. Three patient complaint of the persistent pain at the surgical site and not much improvement in the DASH score.Conclusions: Trapeziectomy with LRTI using flexor carpi radialis (FCR) transfer is an effective treatment for the advanced thumb CMC arthritis. This procedure stabilizes thumb metacarpal and provide enough support which prevents the collapse of metacarpal into dead space.

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Comparison of arthrodesis and arthroplasty of Chinese thumb carpometacarpal osteoarthritis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1469-2 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Jianfeng Li ◽

Dacun Li ◽

Guanglei Tian ◽

Wentong Zhang

Keyword(s):

Grip Strength ◽

Ligament Reconstruction ◽

Subjective Evaluation ◽

Chinese Patients ◽

Pinch Strength ◽

Dash Score ◽

Advantages And Disadvantages ◽

Thumb Carpometacarpal ◽

Tendon Interposition ◽

Carpometacarpal Osteoarthritis

Abstract Background The thumb carpometacarpal (CMC) osteoarthritis is very common. Multiple methods are used to treat progressive thumb CMC osteoarthritis, among which trapeziometacarpal arthrodesis and trapezial excision with ligament reconstruction and tendon interposition (LRTI) are the most common. These two surgical treatment methods have received mixed reviews in previous studies in the west patients. This retrospective study studied the effects, advantages, and disadvantages of arthrodesis and arthroplasty for treating thumb carpometacarpal osteoarthritis in Chinese patients. Methods Between February 2012 and September 2017, 39 Chinese patients with stage II or III thumb carpometacarpal osteoarthritis underwent surgery (trapeziometacarpal arthrodesis in 22, trapezial excision with ligament reconstruction and tendon interposition in 17). Postoperative objective and subjective evaluations were performed. The objective evaluation involved grip strength, pinch strength, thumb abduction degree (palmar and radial), and Kapandji opposition scores. The subjective evaluation involved visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Results Intergroup differences in pinch strength, thumb abduction degrees (palmar and radial), and Kapandji opposition scores were obvious, whereas those in grip strength, VAS score, and DASH score were not. Conclusion In Chinese patients, both techniques relieved pain and improve grip strength. Arthrodesis displayed better pinch strength, while arthroplasty displayed better motor function. Patients were satisfied with the effects of both techniques.

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Trapeziectomy and ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413514500 ◽

2013 ◽

Vol 39 (8) ◽

pp. 833-837 ◽

Cited By ~ 12

Author(s):

R. Langenhan ◽

B. Hohendorff ◽

A. Probst

Keyword(s):

Analogue Scale ◽

Ligament Reconstruction ◽

Pinch Strength ◽

Dash Score ◽

Trapeziometacarpal Osteoarthritis ◽

Osteoarthritis Of The Wrist ◽

Pain At Rest ◽

Tendon Interposition ◽

Median Pain

Isolated osteoarthritis of the scaphotrapeziotrapezoid joint is rather rare compared with thumb trapeziometacarpal osteoarthritis. The aim of this retrospective study was to evaluate the outcome of 15 consecutive patients treated with trapeziectomy/ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist. After a mean follow-up of 54 months, 14 patients (15 wrists) were available for clinical and radiological examination. The median pain intensity was 0 on a 0–10 visual analogue scale, both at rest and with activity, mean grip strength averaged 24 kg, pinch strength 5 kg. The disabilities of the arm, shoulder and hand (DASH) score was 16, and a modified Mayo Wrist Score 84. Correlation between the degree of scaphotrapezoid osteoarthritis and pain at rest, pain with activity, and DASH score was not significant. The findings from our study suggest that trapeziectomy/ligament reconstruction tendon interposition is an effective procedure for treating isolated scaphotrapeziotrapezoid osteoarthritis, and that additional partial trapezoid excision is not necessary.

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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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Mutations in fbiD (Rv2983) as a Novel Determinant of Resistance to Pretomanid and Delamanid in Mycobacterium tuberculosis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01948-20 ◽

2020 ◽

Vol 65 (1) ◽

pp. e01948-20

Author(s):

Dalin Rifat ◽

Si-Yang Li ◽

Thomas Ioerger ◽

Keshav Shah ◽

Jean-Philippe Lanoix ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Clinical Evidence ◽

Clinical Samples ◽

Loss Of Function ◽

Wild Type ◽

Content Type ◽

Solid Media ◽

High Level ◽

Level Resistance

ABSTRACTThe nitroimidazole prodrugs delamanid and pretomanid comprise one of only two new antimicrobial classes approved to treat tuberculosis (TB) in 50 years. Prior in vitro studies suggest a relatively low barrier to nitroimidazole resistance in Mycobacterium tuberculosis, but clinical evidence is limited to date. We selected pretomanid-resistant M. tuberculosis mutants in two mouse models of TB using a range of pretomanid doses. The frequency of spontaneous resistance was approximately 10−5 CFU. Whole-genome sequencing of 161 resistant isolates from 47 mice revealed 99 unique mutations, of which 91% occurred in 1 of 5 genes previously associated with nitroimidazole activation and resistance, namely, fbiC (56%), fbiA (15%), ddn (12%), fgd (4%), and fbiB (4%). Nearly all mutations were unique to a single mouse and not previously identified. The remaining 9% of resistant mutants harbored mutations in Rv2983 (fbiD), a gene not previously associated with nitroimidazole resistance but recently shown to be a guanylyltransferase necessary for cofactor F420 synthesis. Most mutants exhibited high-level resistance to pretomanid and delamanid, although Rv2983 and fbiB mutants exhibited high-level pretomanid resistance but relatively small changes in delamanid susceptibility. Complementing an Rv2983 mutant with wild-type Rv2983 restored susceptibility to pretomanid and delamanid. By quantifying intracellular F420 and its precursor Fo in overexpressing and loss-of-function mutants, we provide further evidence that Rv2983 is necessary for F420 biosynthesis. Finally, Rv2983 mutants and other F420H2-deficient mutants displayed hypersusceptibility to some antibiotics and to concentrations of malachite green found in solid media used to isolate and propagate mycobacteria from clinical samples.

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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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Comparison of simulated key pinch after three surgical procedures for trapeziometacarpal osteoarthritis: a cadaver study

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211015915 ◽

2021 ◽

pp. 175319342110159

Author(s):

Lionel Athlani ◽

Damien Motte ◽

Marie Martel ◽

Florent Moissenet ◽

Julie Mottet ◽

...

Keyword(s):

Surgical Procedures ◽

Total Joint Arthroplasty ◽

Ligament Reconstruction ◽

Cadaver Study ◽

Joint Arthroplasty ◽

Pinch Force ◽

Trapeziometacarpal Osteoarthritis ◽

Intact Sample ◽

Significant Difference ◽

Tendon Interposition

We performed a cadaver study using 18 fresh-frozen adult forearms and hands to compare the tendon loads required to generate progressively greater key pinch (0.5 kg to 2 kg) after three different surgical procedures to treat trapeziometacarpal osteoarthritis: isolated trapeziectomy, trapeziectomy followed by ligament reconstruction with tendon interposition and total joint arthroplasty using a Touch® implant. Thumb pinch was simulated by loading the main actuator tendons involved in the key pinch. Six specimens were randomly assigned to each of the three surgical procedure groups. Measurements were made before and after the joint surgery. Specimens that underwent trapeziectomy with or without ligament reconstruction with tendon interposition required significantly higher tendon loads than those with the implant to achieve the same pinch force. There was no significant difference between the isolated trapeziectomy and ligament reconstruction groups. Using the implant resulted in similar median tendon loads compared with those of the intact sample. Total joint arthroplasty with a Touch® prosthesis may yield a superior biomechanical profile in which the tendon loads needed to achieve a certain key pinch force are lower and better distributed between the actuator muscles compared with trapeziectomy with or without ligament reconstruction.

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LINC00680 enhances hepatocellular carcinoma stemness behavior and chemoresistance by sponging miR-568 to upregulate AKT3

Journal of Experimental & Clinical Cancer Research ◽

10.1186/s13046-021-01854-5 ◽

2021 ◽

Vol 40 (1) ◽

Author(s):

Gege Shu ◽

Huizhao Su ◽

Zhiqian Wang ◽

Shihui Lai ◽

Yan Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Xenograft Model ◽

Luciferase Reporter ◽

Loss Of Function ◽

Mechanism Study ◽

Downstream Signaling ◽

Mouse Xenograft Model ◽

High Level

Abstract Background Hepatocellular carcinoma (HCC) has an extremely poor prognosis due to the development of chemoresistance, coupled with inherently increased stemness properties. Long non-coding RNAs (LncRNAs) are key regulators for tumor cell stemness and chemosensitivity. Currently the relevance between LINC00680 and tumor progression was still largely unknown, with only one study showing its significance in glioblastoma. The study herein was aimed at identifying the role of LINC00680 in the regulation HCC stemness and chemosensitivity. Methods QRT-PCR was used to detect the expression of LINC00680, miR-568 and AKT3 in tissue specimen and cell lines. Gain- or loss-of function assays were applied to access the function of LINC00680 in HCC cells, including cell proliferation and stemness properties. HCC stemness and chemosensitivity were determined by sphere formation, cell viability and colony formation. Luciferase reporter, RNA immunoprecipitation (RIP), and RNA pull-down assays were performed to examine the interaction between LINC00680 and miR-568 as well as that between miR-568 and AKT3. A nude mouse xenograft model was established for the in vivo study. Results We found that LINC00680 was remarkably upregulated in HCC tissues. Patients with high level of LINC00680 had poorer prognosis. LINC00680 overexpression significantly enhanced HCC cell stemness and decreased in vitro and in vivo chemosensitivity to 5-fluorouracil (5-Fu), whereas LINC00680 knockdown led to opposite results. Mechanism study revealed that LINC00680 regulated HCC stemness and chemosensitivity through sponging miR-568, thereby expediting the expression of AKT3, which further activated its downstream signaling molecules, including mTOR, elF4EBP1, and p70S6K. Conclusion LINC00680 promotes HCC stemness properties and decreases chemosensitivity through sponging miR-568 to activate AKT3, suggesting that LINC00680 might be a potentially important HCC diagnosis marker and therapeutic target.

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Ligament Reconstruction Basal Joint Arthroplasty Without Tendon Interposition

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-199709000-00008 ◽

1997 ◽

Vol 342 ◽

pp. 42???45 ◽

Cited By ~ 45

Author(s):

Michelle Gerwin ◽

Annabel Griffith ◽

Andrew J. Weiland ◽

Robert N. Hotchkiss ◽

Richard R. McCormack

Keyword(s):

Ligament Reconstruction ◽

Joint Arthroplasty ◽

Basal Joint ◽

Tendon Interposition

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Rune-Gild

International Journal for the Study of New Religions ◽

10.1558/ijsnr.v1i1.95 ◽

2010 ◽

Vol 1 (1) ◽

pp. 95-115 ◽

Cited By ~ 1

Author(s):

Kennet Granholm

Keyword(s):

Frame Of Reference ◽

Left Hand ◽

Hand Path ◽

High Level ◽

Complex Movement ◽

Common Frame Of Reference

The focus of this article is the Rune-Gild, a rune magical group founded in Texas, USA, in 1980, and which has variously been described as a Heathen, a Traditionalist, and a Left-Hand Path organization. The influence of these three esoteric currents on the Gild is examined, as is the issue of how they intermix to fit a common frame of reference. The article argues that describing a complex movement such as the Rune-Gild in a singular fashion, by referencing to only one of these currents, involves the risk of providing a one-sided and ultimately inaccurate depiction. Instead, a description involving a thorough examination of all major influences is required, and this in turn makes it necessary for the scholar to achieve a high-level historical familiarity with a broad range of Western religious phenomena.

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