Ligament reconstruction of the painful, unstable, nonarthritic thumb carpometacarpal joint

Thirty-seven cases of ligament reconstruction of the nonarthritic thumb carpometacarpal joint were performed in 35 patients, 29 female and 6 male, between 1980 and 1996. Follow-up ranged from 1 to 17 years with an average of 5.2 years. The procedure described by Eaton and Littler in which a slip of the flexor carpi radialis (FCR) weaved through the first metacarpal and around the abductor pollicis longus and FCR was used. All patients had marked pain before surgery, and 65% were unable to work. No patient had radiographic evidence of arthritis before surgery. Sixty-seven percent had excellent results, and 30% had good results. All but 1 had complete or nearly complete pain relief. One hundred percent had good stability and improved pinch strength. All patients were able to return to work, 94% to their prior level of performance. There was no clinical or x-ray evidence of osteoarthritis in any patient at final follow-up.