Use of the entire flexor carpi radialis tendon for basal thumb ligament reconstruction interposition arthroplasty

Recent studies seem to show that ligament reconstruction with tendon interposition (LRTI) does not provide any benefit over trapezium excision alone; however dorsal subluxation was not measured in these studies. We believe it is logical to perform ligamentoplasty in order to obtain long-term stability and therefore treat dorsal subluxation. Our aim is to verify this hypothesis in an observational prospective study of LRTI using the entire flexor carpi radialis (FCR) tendon. Patients who had failed to respond to nonoperative treatment for advanced thumb basal joint arthritis were recruited prospectively between 2007 and 2011. They all received the same surgical treatment, which consisted of LRTI using the entire FCR tendon. Pre- and postoperative pain, range of motion, strength, stability of the base of the first metacarpal and DASH scores were evaluated. Forty-three patients (49 thumbs) were included with a mean follow-up of 37months (range: 29-72months). Patients showed significant improvements in pain, range of motion and pinch strength. The dorsoradial subluxation was no longer present in any of the thumbs, and the grind test was positive in only three thumbs. The DASH score was improved from 49/100 preoperatively to 22/100 postoperatively. No ulnar deviation of the wrist was observed at the longest follow-up and grip strength was not altered by the procedure. This study showed that the use of the full FCR tendon for LRTI in combination with trapeziectomy is an efficient and safe treatment for advanced carpometacarpal osteoarthritis as it provides a strong ligamentoplasty with a bulky interposition.

Clinical study, Therapeutic Study: Level IV.