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Treatment of osteoarthritis of the first carpometacarpal joint by resection–suspension–interposition arthoplasty using the split abductor pollicis longus tendon

Behandlung der Rhizarthrose durch Resektions-Suspensions-Interpositionsarthroplastik mit der gespaltenen Abduktor-pollicis-longus-Sehne

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Abstract

Objective

Reduction of pain and gain of functionality in symptomatic osteoarthritis of the first carpometacarpal joint.

Indications

Idiopathic, rheumatic, or posttraumatic osteoarthritis of the first carpometacarpal joint.

Relative contraindications

Poor general condition, poor condition of the hand’s soft tissue/skin, chronic regional pain syndrome, current or recent infections of the hand, heavy manual labor (decision on a by-case basis).

Surgical technique

Supine position, hand pronated or slightly tilted. Upper arm tourniquet (Esmarch’s method). Loupe magnification. Incision over the first extensor compartment. Exposure and incision of the thumb’s basal joint. Resection of the trapezium. Exposure of the abductor pollicis longus (APL) tendon. Longitudinal split of the tendon harvesting the distally based ulnar part of the tendon. The split APL tendon is wrapped around the flexor carpi radialis (FCR) muscle tendon, suturing it to the tendon and back to itself. The rest of the split APL tendon is placed into the gap between the scaphoid and the first metacarpal bone, which is followed by wound closure.

Postoperative management

Plaster cast (thumb abduction splint) for 4 weeks. Stable commercially available wrist brace for at least 2 more weeks.

Results

There were no significant differences between the FCR arthroplasty (Epping’s method) and the APL arthroplasty (Wulle’s technique) regarding pain (visual analog scale), disability/usability (DASH score), or range of motion. Patients who had undergone APL arthroplasty showed significantly better grip and pinch strength. Furthermore, the operating time was significantly shorter and scars were significantly smaller in APL arthroplasty.

Zusammenfassung

Operationsziel

Schmerzlinderung und Funktionszugewinn bei symptomatischer Rhizarthrose.

Indikationen

Idiopathische, rheumatische oder posttraumatische Rhizarthrose.

Relative Kontraindikationen

Schlechter Allgemeinzustand, schlechter Zustand der Weichteile der Hand, chronisches regionales Schmerzsyndrom (CRPS), akute oder kurz zurückliegende Infektionen der Hand und schwere manuelle Tätigkeit (Einzelfallentscheidung).

Operationstechnik

Rückenlage, Hand seitlich auf einem Armtisch ausgelagert, Hand proniert oder leicht schräg gelagert. Esmarch-Blutleere. Lupenbrille. Inzision über dem 1. Strecksehnenfach. Eröffnung des Daumensattelgelenks. Resektion des Os trapezium. Darstellung der Sehne des M. abductor pollicis longus (APL). Hälftiges Spalten der Sehne. Proximales Absetzen des ulnaren Teils. Umschlagen des abgesetzten Sehnenzügels um die Sehne des M. flexor carpi radialis (FCR). Vernähen der beiden Sehnen unter Spannung. Auffädeln des verbleibenden ulnaren APL-Zügels und Vernähen mit sich selbst. Interposition zwischen Os scaphoideum und Basis des 1. Os metacarpale mit anschließendem Wundverschluss.

Weiterbehandlung

Ruhigstellung im Gipsverband mit Daumenabduktion („Autostop-Schiene“) für mindestens 4 Wochen, danach feste kommerzielle Handgelenksbandage für mindestens 2 weitere Wochen.

Ergebnisse

Bei einem Vergleich der APL-Arthroplastik mit der FCR-Arthroplastik zeigen sich – Literaturangaben zufolge – keine signifikanten Unterschiede bezüglich Schmerzen (VAS), Funktion (DASH-Score) oder Bewegungsausmaß. Jedoch zeigten die mit einer APL-Arthroplastik operierten Patienten eine signifikant bessere Kraft für den Grob- sowie Pinzettengriff. Zusätzlich waren die Operationszeiten signifikant kürzer und die Narben signifikant kleiner.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany

    P.S. Harenberg M.D., M.G. Jakubietz, R.G. Jakubietz, K. Schmidt & R.H. Meffert

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  1. P.S. Harenberg M.D.
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  2. M.G. Jakubietz
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  3. R.G. Jakubietz
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  4. K. Schmidt
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  5. R.H. Meffert
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Correspondence to P.S. Harenberg M.D..

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Harenberg, P., Jakubietz, M., Jakubietz, R. et al. Treatment of osteoarthritis of the first carpometacarpal joint by resection–suspension–interposition arthoplasty using the split abductor pollicis longus tendon. Oper Orthop Traumatol 25, 95–103 (2013). https://doi.org/10.1007/s00064-011-0082-2

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  • DOI: https://doi.org/10.1007/s00064-011-0082-2

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