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Partial trapeziectomy for Eaton stage III thumb carpometacarpal arthritis: ligament reconstruction with tendon interposition using the entire flexor carpi radialis and interference screw fixation

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is currently the most popular technique for treating primary osteoarthritis of the thumb carpometacarpal joint. However, reduced trapezial height has sometimes been reported after LRTI. Longer immobilization and delayed rehabilitation times are also problematic. In this study, we evaluated the clinical and radiological outcomes of patients who underwent our modified LRTI procedure.

Methods

Retrospective study included 26 thumbs in 24 cases with advanced stages. Our modified Burton’s procedure was as follows: (1) trapeziectomy was limited to distal-half, (2) the entire flexor carpi radialis (FCR) was harvested from the forearm, and (3) half-slip of the FCR tendon was stabilized by interference screw in the first metacarpal bone tunnel.

Results

Pain on the visual analogue scale (VAS), the quick Disabilities of the Arm Shoulder and Hand score, tip pinch strength significantly improved postoperatively. The preoperative height of the trapezial space was well-maintained at final follow-up. Magnetic resonance imaging at the one-year follow-up showed the existence of FCR tendon ball in 15 cases. Eighteen housewives resumed their daily activities after a mean period of 10 days postoperative, while another 6 patients returned to their original jobs after 3 weeks.

Conclusions

Our modified LRTI method involves distal-half trapeziectomy and entire FCR interposition. A sewn FCR tendon ball always provide enough volume to fill the trapeziectomy space, which helps to prevent sinking of the metacarpal bone. Our technique produced sufficient ligamentoplasty and allowed early mobilization after surgery.

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Funding

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan

    Keiichi Muramatsu, Yasuhiro Tani, Tetsuya Seto, Jasson Arcinue & Felma Rayel

  2. Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan

    Keiichi Muramatsu, Takahiro Hashimoto, Ryuta Iwanaga & Takashi Sakai

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  1. Keiichi Muramatsu
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  2. Yasuhiro Tani
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  5. Felma Rayel
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  6. Takahiro Hashimoto
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  8. Takashi Sakai
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Correspondence to Keiichi Muramatsu.

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Muramatsu, K., Tani, Y., Seto, T. et al. Partial trapeziectomy for Eaton stage III thumb carpometacarpal arthritis: ligament reconstruction with tendon interposition using the entire flexor carpi radialis and interference screw fixation. Eur J Orthop Surg Traumatol 32, 151–157 (2022). https://doi.org/10.1007/s00590-020-02863-4

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  • DOI: https://doi.org/10.1007/s00590-020-02863-4

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